diff --git a/src/components/Page/Page.tsx b/src/components/Page/Page.tsx
index 23f437ce..90605bab 100644
--- a/src/components/Page/Page.tsx
+++ b/src/components/Page/Page.tsx
@@ -13,6 +13,7 @@ const Page = ({ children, title, 'data-cy': dataCy }: PageProps) => {
       sx={{
         color: '#60718c',
         maxHeight: '55vh',
+        width: '100%',
         overflowY: 'auto',
         gap: '2.5rem'
       }}
diff --git a/src/components/Pages/Contact.tsx b/src/components/Pages/Contact.tsx
index 7c2b711d..37667487 100644
--- a/src/components/Pages/Contact.tsx
+++ b/src/components/Pages/Contact.tsx
@@ -1,42 +1,191 @@
 import { useState } from 'react';
-import { Box, CircularProgress } from '@mui/material';
+import {
+  Checkbox,
+  Stack,
+  Button,
+  FormControlLabel,
+  Alert,
+  Collapse,
+  Typography
+} from '@mui/material';
+import { FormProvider, useForm, Controller } from 'react-hook-form';
+import { zodResolver } from '@hookform/resolvers/zod';
+import { addFeedback } from 'services/db';
+import Page from 'components/Page/Page';
+import feedbackFormSchema, {
+  type FeedbackFormValues
+} from 'schemas/feedbackFormSchema';
+import FormTextField from 'components/forms/FormTextField/FormTextField';
+import ClearFormIcon from 'icons/ClearFormIcon';
+
+type FormValues = FeedbackFormValues;
+
+const TITLE = 'Contact Us';
+const PRIMARY_COLOR = '#10b6ff';
+const textFieldFocus = {
+  '& .MuiOutlinedInput-root': {
+    '&.Mui-focused fieldset': {
+      borderColor: PRIMARY_COLOR
+    }
+  },
+  '& .MuiInputLabel-root.Mui-focused': {
+    color: PRIMARY_COLOR
+  }
+};
+const SCHEMA = feedbackFormSchema;
 
 const Contact = () => {
-  const [loading, setLoading] = useState(true);
+  const [status, setStatus] = useState<'idle' | 'success' | 'error'>('idle');
+
+  const methods = useForm<FormValues>({
+    defaultValues: {
+      name: '',
+      email: '',
+      feedback: '',
+      interest: false
+    },
+    resolver: zodResolver(SCHEMA)
+  });
+
+  const {
+    handleSubmit,
+    control,
+    reset,
+    formState: { isSubmitting }
+  } = methods;
+
+  const onSubmit = async (data: FormValues) => {
+    setStatus('idle');
+    try {
+      await addFeedback(data);
+      setStatus('success');
+      reset();
+    } catch (error) {
+      console.error(error);
+      setStatus('error');
+    }
+  };
 
-  const handleLoading = () => {
-    setLoading(false);
+  const handleClear = () => {
+    reset();
+    setStatus('idle');
   };
 
   return (
-    <Box sx={{ height: '460px', width: '100%', position: 'relative' }}>
-      {loading && (
-        <Box
-          sx={{
-            position: 'absolute',
-            top: 0,
-            left: 0,
-            width: '100%',
-            height: '100%',
-            display: 'flex',
-            alignItems: 'center',
-            justifyContent: 'center'
-          }}
-        >
-          <CircularProgress />
-        </Box>
-      )}
-
-      <iframe
-        title="Contact Us"
-        className="airtable-embed"
-        src="https://airtable.com/embed/appyNdhZZn3gpovFh/pagDtKnlb6n3mCpgd/form"
-        width="100%"
-        height="460px"
-        style={{ background: 'transparent', border: 'none' }}
-        onLoad={handleLoading}
-      />
-    </Box>
+    <Page title={TITLE} data-cy="contact-us">
+      <FormProvider {...methods}>
+        <form onSubmit={handleSubmit(onSubmit)} style={{ width: '75%' }}>
+          <Stack gap={2}>
+            <Collapse in={status !== 'idle'}>
+              {status === 'success' && (
+                <Alert severity="success" onClose={() => setStatus('idle')}>
+                  Thank you! Your feedback has been received!
+                </Alert>
+              )}
+              {status === 'error' && (
+                <Alert severity="error" onClose={() => setStatus('idle')}>
+                  Something went wrong please try again after sometime.
+                </Alert>
+              )}
+            </Collapse>
+
+            <FormTextField<FormValues>
+              name="name"
+              label="Name"
+              placeholder="Enter Your Name"
+              required
+              fullWidth
+              sx={textFieldFocus}
+            />
+
+            <FormTextField<FormValues>
+              name="email"
+              label="Email"
+              placeholder="example@email.com"
+              required
+              fullWidth
+              sx={textFieldFocus}
+            />
+
+            <FormTextField<FormValues>
+              name="feedback"
+              label="Feedback"
+              placeholder="Share your feedback and thoughts"
+              multiline
+              minRows={3}
+              fullWidth
+              sx={textFieldFocus}
+              helperText="Please do not include any sensitive personal information."
+              slotProps={{
+                formHelperText: {
+                  sx: {
+                    color: 'gray',
+                    fontSize: '0.75rem',
+                    fontStyle: 'italic',
+                    marginLeft: '1px'
+                  }
+                }
+              }}
+            />
+
+            <Controller
+              name="interest"
+              control={control}
+              render={({ field }) => (
+                <FormControlLabel
+                  control={
+                    <Checkbox
+                      {...field}
+                      checked={field.value}
+                      sx={{
+                        '&.Mui-checked': { color: PRIMARY_COLOR }
+                      }}
+                    />
+                  }
+                  label={
+                    <Typography
+                      sx={{ fontSize: 14, fontWeight: 500, lineHeight: '24px' }}
+                    >
+                      I'm interested in helping PHLASK with future research
+                    </Typography>
+                  }
+                />
+              )}
+            />
+
+            <Stack direction="row" gap={5} mt={2}>
+              <Button
+                variant="text"
+                onClick={handleClear}
+                sx={{ color: PRIMARY_COLOR }}
+                startIcon={<ClearFormIcon />}
+              >
+                clear form
+              </Button>
+              <Button
+                variant="contained"
+                type="submit"
+                disabled={isSubmitting || status === 'success'}
+                sx={{
+                  fontWeight: 'bold',
+                  backgroundColor: PRIMARY_COLOR,
+                  '&:hover': {
+                    backgroundColor: PRIMARY_COLOR,
+                    boxShadow: `0 0 10px ${PRIMARY_COLOR}80`
+                  }
+                }}
+              >
+                {isSubmitting
+                  ? 'Submitting...'
+                  : status === 'success'
+                  ? 'Submitted'
+                  : 'Submit'}
+              </Button>
+            </Stack>
+          </Stack>
+        </form>
+      </FormProvider>
+    </Page>
   );
 };
 
diff --git a/src/components/forms/FormTextField/FormTextField.tsx b/src/components/forms/FormTextField/FormTextField.tsx
index 45e6f490..7d783c64 100644
--- a/src/components/forms/FormTextField/FormTextField.tsx
+++ b/src/components/forms/FormTextField/FormTextField.tsx
@@ -1,4 +1,4 @@
-import { TextField } from '@mui/material';
+import { TextField, type TextFieldProps } from '@mui/material';
 import type { ReactNode } from 'react';
 import {
   useFormContext,
@@ -10,23 +10,29 @@ import {
 type FormTextFieldProps<Values extends FieldValues> = {
   name: Path<Values>;
   label: ReactNode;
+  placeholder?: string;
   disabled?: boolean;
   helperText?: ReactNode;
   fullWidth?: boolean;
   required?: boolean;
   multiline?: boolean;
   minRows?: number;
+  slotProps?: TextFieldProps['slotProps'];
+  sx?: TextFieldProps['sx'];
 };
 
 const FormTextField = <Values extends FieldValues>({
   name,
   label,
+  placeholder,
   helperText,
   disabled = false,
   required = false,
   fullWidth = false,
   multiline = false,
-  minRows = undefined
+  minRows = undefined,
+  slotProps,
+  sx
 }: FormTextFieldProps<Values>) => {
   const { register, getFieldState } = useFormContext<Values>();
   const formState = useFormState<Values>({
@@ -39,12 +45,20 @@ const FormTextField = <Values extends FieldValues>({
     <TextField
       {...register(name, { required, disabled })}
       label={label}
+      placeholder={placeholder}
       helperText={error?.message || helperText || ' '}
       fullWidth={fullWidth}
-      slotProps={{ inputLabel: { required } }}
+      slotProps={{
+        ...slotProps,
+        inputLabel: {
+          required,
+          ...slotProps?.inputLabel
+        }
+      }}
       error={invalid}
       multiline={multiline}
       minRows={minRows}
+      sx={sx}
     />
   );
 };
diff --git a/src/icons/ClearFormIcon.tsx b/src/icons/ClearFormIcon.tsx
new file mode 100644
index 00000000..7cbe0e17
--- /dev/null
+++ b/src/icons/ClearFormIcon.tsx
@@ -0,0 +1,20 @@
+import type { SVGProps } from 'react';
+
+const SvgClearFormIcon = (props: SVGProps<SVGSVGElement>) => (
+  <svg
+    xmlns="http://www.w3.org/2000/svg"
+    width="0.7em"
+    height="0.7em"
+    viewBox="0 0 16 16"
+    fill="#10b6ff"
+    {...props}
+  >
+    <path
+      fillRule="evenodd"
+      clipRule="evenodd"
+      d="M13.9907 0c.8909 0 1.337.1077 1.337 1.1077L14.6978 1.7071l-.8422.8421c.5654.6073 1.0348 1.301 1.3892 2.0577.558 1.1914.8135 2.502.744 3.8158-.0695 1.3138-.462 2.5902-1.1426 3.7161-.6806 1.1258-1.6284 2.0665-2.7594 2.7385-1.131.6721-2.4103 1.0549-3.7245 1.1145-1.3143.0596-2.623-.2059-3.8101-.7729-1.1872-.5669-2.2162-1.418-2.9959-2.4776C.7766 11.6816.2703 10.446.0822 9.1439c-.079-.5466.3001-1.0537.8467-1.1327s1.0538.3001 1.1327.8467c.1411.9766.5209 1.9033 1.1057 2.6981.5848.7947 1.3565 1.433 2.2469 1.8582.8904.4252 1.8719.6243 2.8576.5797.9857-.0447 1.9452-.3318 2.7934-.8359.8482-.5041 1.5591-1.2095 2.0695-2.0539.5105-.8444.8049-1.8017.857-2.787.0521-.9853-.1395-1.9683-.558-2.8619-.2556-.5457-.591-1.0478-.9934-1.4906l-.7331.7332c-.63 1.263-1.7071.8168-1.7071-.0741V0h3.9907zM1.5 4c.5523 0 1 .4477 1 1s-.4477 1-1 1-1-.4477-1-1 .4477-1 1-1zm2.25-2.75c.5523 0 1 .4477 1 1s-.4477 1-1 1-1-.4477-1-1 .4477-1 1-1zm3.25-1.25c.5523 0 1 .4477 1 1s-.4477 1-1 1-1-.4477-1-1 .4477-1 1-1z"
+    />
+  </svg>
+);
+
+export default SvgClearFormIcon;
diff --git a/src/icons/JoinDataIcon.tsx b/src/icons/JoinDataIcon.tsx
index d4247e49..37e4a102 100644
--- a/src/icons/JoinDataIcon.tsx
+++ b/src/icons/JoinDataIcon.tsx
@@ -1,27 +1,35 @@
 import type { SVGProps } from 'react';
+
 const SvgJoinDataIcon = (props: SVGProps<SVGSVGElement>) => (
   <svg
     xmlns="http://www.w3.org/2000/svg"
     width="1em"
     height="1em"
+    viewBox="0 0 256 256"
     fill="none"
-    viewBox="0 0 30 31"
     {...props}
   >
-    <path
-      stroke="#2D3848"
+    <g
+      stroke="#000"
+      strokeWidth={12}
       strokeLinecap="round"
       strokeLinejoin="round"
-      strokeWidth={1.622}
-      d="m22.047 4.288 4.174 4.175L7.517 27.167a.22.22 0 0 1-.321 0l-3.853-3.853a.22.22 0 0 1 0-.321zM27.424 2.158l.928.929a2.31 2.31 0 0 1 0 3.257l-2.121 2.121-4.174-4.174 2.121-2.122a2.31 2.31 0 0 1 3.257 0zM9.635 14.102l-7.93-7.93 4.93-4.93 7.395 7.395-2.027 2.01M18.864 19.26l2.886-2.887 7.38 7.363-4.93 4.93-7.931-7.93M7.121 5.766l2.011-2.011M8.679 9.058l2.887-2.886M22.122 20.768l2.011-2.027M23.858 24.24l2.887-2.888"
-    />
-    <path
-      stroke="#2D3848"
-      strokeLinecap="round"
-      strokeLinejoin="round"
-      strokeWidth={1.622}
-      d="m7.43 27.32-6.261 2.027 2.011-6.212"
-    />
+    >
+      <path
+        fill="#000"
+        fillRule="evenodd"
+        d="M239.985 55.994c0 22.089-50.138 39.994-111.985 39.994S16.015 78.083 16.015 55.994 66.153 16 128 16s111.985 17.905 111.985 39.994z"
+      />
+
+      <path d="M239.985 103.987c-13.998 21.648-55.992 34.637-111.985 34.637s-97.987-12.989-111.985-34.637" />
+
+      <path d="M239.985 151.981c-13.998 21.647-55.992 34.636-111.985 34.636s-97.987-12.989-111.985-34.636" />
+
+      <path d="M239.985 199.974c-13.998 21.648-55.992 34.637-111.985 34.637s-97.987-12.989-111.985-34.637" />
+
+      <path d="M16.015 55.994v143.98M239.985 55.994v143.98" />
+    </g>
   </svg>
 );
+
 export default SvgJoinDataIcon;
diff --git a/src/schemas/feedbackFormSchema.ts b/src/schemas/feedbackFormSchema.ts
new file mode 100644
index 00000000..421aad26
--- /dev/null
+++ b/src/schemas/feedbackFormSchema.ts
@@ -0,0 +1,11 @@
+import * as z from 'zod';
+
+const feedbackFormSchema = z.object({
+  name: z.string().min(1, 'Name is required'),
+  email: z.string().min(1, 'Email is required').email('Invalid email'),
+  feedback: z.string().optional(),
+  interest: z.boolean()
+});
+
+export type FeedbackFormValues = z.infer<typeof feedbackFormSchema>;
+export default feedbackFormSchema;
diff --git a/src/services/db.ts b/src/services/db.ts
index ae21ac51..39e497c6 100644
--- a/src/services/db.ts
+++ b/src/services/db.ts
@@ -1,5 +1,5 @@
 import { createClient } from '@supabase/supabase-js';
-import type { ResourceEntry } from 'types/ResourceEntry';
+import type { FeedbackForm, ResourceEntry } from 'types/ResourceEntry';
 import type { ResourceTypeOption } from 'hooks/useResourceType';
 import type { Contributor } from 'types/Contributor';
 
@@ -11,6 +11,7 @@ const databaseApiKey =
   import.meta.env.VITE_DB_API_KEY ||
   'eyJhbGciOiJIUzI1NiIsInR5cCI6IkpXVCJ9.eyJpc3MiOiJzdXBhYmFzZSIsInJlZiI6IndhbnR5Y2Zibnp6b2NzYnRocXpzIiwicm9sZSI6ImFub24iLCJpYXQiOjE3MzcwNDY2OTgsImV4cCI6MjA1MjYyMjY5OH0.yczsMOx3Y-zsWu-GjYEajIb0yw9fYWEIUglmmfM1zCY';
 const contributorDatabaseName = 'airtable_contributors';
+const feedbackDatabaseName = 'airtable_feedback';
 
 const supabase = createClient(databaseUrl, databaseApiKey);
 
@@ -116,6 +117,18 @@ export const addResource = async (resource: ResourceEntry) => {
   return data;
 };
 
+export const addFeedback = async (feedback: FeedbackForm) => {
+  const { data, error } = await supabase
+    .from(feedbackDatabaseName)
+    .insert(feedback)
+    .select();
+
+  if (error) {
+    throw error;
+  }
+  return data;
+};
+
 export const getContributors = async (): Promise<Contributor[]> => {
   const { data, error } = await supabase
     .from(contributorDatabaseName)
diff --git a/src/types/ResourceEntry.ts b/src/types/ResourceEntry.ts
index f25bdb0d..2ab31c46 100644
--- a/src/types/ResourceEntry.ts
+++ b/src/types/ResourceEntry.ts
@@ -178,3 +178,10 @@ export type ResourceEntry = {
   /**  If the resource_type is BATHROOM, the information about the bathroom resource. */
   bathroom?: BathroomInfo | null;
 };
+
+export type FeedbackForm = {
+  name: string | null;
+  email: string | null;
+  feedback?: string | null;
+  interest?: boolean | null;
+};