[contact-form][contact-field label="Name" type="name" required="1"][contact-field label="Email" type="email" required="1"][contact-field label="Phone Number" type="text" required="1"][contact-field label="Home Address " type="text"][contact-field label="Insurance Provider" type="text" required="1"][contact-field label="Policy Number" type="text" required="1"][contact-field label="Extent of Damage (Minimal, Mild, Severe)" type="text" required="1"][contact-field label="Preferred Method of Contact (Email, Phone Call)" type="text"][/contact-form]