diff --git a/ipi-survey-platform/package-lock.json b/ipi-survey-platform/package-lock.json
index 8b9f59e..48d243e 100644
--- a/ipi-survey-platform/package-lock.json
+++ b/ipi-survey-platform/package-lock.json
@@ -11,6 +11,7 @@
         "axios": "^1.12.2",
         "react": "^19.1.1",
         "react-dom": "^19.1.1",
+        "react-google-recaptcha": "^3.1.0",
         "react-router-dom": "^7.9.4"
       },
       "devDependencies": {
@@ -2729,6 +2730,15 @@
         "node": ">= 0.4"
       }
     },
+    "node_modules/hoist-non-react-statics": {
+      "version": "3.3.2",
+      "resolved": "https://registry.npmjs.org/hoist-non-react-statics/-/hoist-non-react-statics-3.3.2.tgz",
+      "integrity": "sha512-/gGivxi8JPKWNm/W0jSmzcMPpfpPLc3dY/6GxhX2hQ9iGj3aDfklV4ET7NjKpSinLpJ5vafa9iiGIEZg10SfBw==",
+      "license": "BSD-3-Clause",
+      "dependencies": {
+        "react-is": "^16.7.0"
+      }
+    },
     "node_modules/ignore": {
       "version": "5.3.2",
       "resolved": "https://registry.npmjs.org/ignore/-/ignore-5.3.2.tgz",
@@ -2810,7 +2820,6 @@
       "version": "4.0.0",
       "resolved": "https://registry.npmjs.org/js-tokens/-/js-tokens-4.0.0.tgz",
       "integrity": "sha512-RdJUflcE3cUzKiMqQgsCu06FPu9UdIJO0beYbPhHN4k6apgJtifcoCtT9bcxOpYBtpD2kCM6Sbzg4CausW/PKQ==",
-      "dev": true,
       "license": "MIT"
     },
     "node_modules/js-yaml": {
@@ -3159,6 +3168,18 @@
       "dev": true,
       "license": "MIT"
     },
+    "node_modules/loose-envify": {
+      "version": "1.4.0",
+      "resolved": "https://registry.npmjs.org/loose-envify/-/loose-envify-1.4.0.tgz",
+      "integrity": "sha512-lyuxPGr/Wfhrlem2CL/UcnUc1zcqKAImBDzukY7Y5F/yQiNdko6+fRLevlw1HgMySw7f611UIY408EtxRSoK3Q==",
+      "license": "MIT",
+      "dependencies": {
+        "js-tokens": "^3.0.0 || ^4.0.0"
+      },
+      "bin": {
+        "loose-envify": "cli.js"
+      }
+    },
     "node_modules/lru-cache": {
       "version": "5.1.1",
       "resolved": "https://registry.npmjs.org/lru-cache/-/lru-cache-5.1.1.tgz",
@@ -3295,6 +3316,15 @@
         "node": ">=0.10.0"
       }
     },
+    "node_modules/object-assign": {
+      "version": "4.1.1",
+      "resolved": "https://registry.npmjs.org/object-assign/-/object-assign-4.1.1.tgz",
+      "integrity": "sha512-rJgTQnkUnH1sFw8yT6VSU3zD3sWmu6sZhIseY8VX+GRu3P6F7Fu+JNDoXfklElbLJSnc3FUQHVe4cU5hj+BcUg==",
+      "license": "MIT",
+      "engines": {
+        "node": ">=0.10.0"
+      }
+    },
     "node_modules/optionator": {
       "version": "0.9.4",
       "resolved": "https://registry.npmjs.org/optionator/-/optionator-0.9.4.tgz",
@@ -3444,6 +3474,17 @@
         "node": ">= 0.8.0"
       }
     },
+    "node_modules/prop-types": {
+      "version": "15.8.1",
+      "resolved": "https://registry.npmjs.org/prop-types/-/prop-types-15.8.1.tgz",
+      "integrity": "sha512-oj87CgZICdulUohogVAR7AjlC0327U4el4L6eAvOqCeudMDVU0NThNaV+b9Df4dXgSP1gXMTnPdhfe/2qDH5cg==",
+      "license": "MIT",
+      "dependencies": {
+        "loose-envify": "^1.4.0",
+        "object-assign": "^4.1.1",
+        "react-is": "^16.13.1"
+      }
+    },
     "node_modules/proxy-from-env": {
       "version": "1.1.0",
       "resolved": "https://registry.npmjs.org/proxy-from-env/-/proxy-from-env-1.1.0.tgz",
@@ -3469,6 +3510,19 @@
         "node": ">=0.10.0"
       }
     },
+    "node_modules/react-async-script": {
+      "version": "1.2.0",
+      "resolved": "https://registry.npmjs.org/react-async-script/-/react-async-script-1.2.0.tgz",
+      "integrity": "sha512-bCpkbm9JiAuMGhkqoAiC0lLkb40DJ0HOEJIku+9JDjxX3Rcs+ztEOG13wbrOskt3n2DTrjshhaQ/iay+SnGg5Q==",
+      "license": "MIT",
+      "dependencies": {
+        "hoist-non-react-statics": "^3.3.0",
+        "prop-types": "^15.5.0"
+      },
+      "peerDependencies": {
+        "react": ">=16.4.1"
+      }
+    },
     "node_modules/react-dom": {
       "version": "19.2.0",
       "resolved": "https://registry.npmjs.org/react-dom/-/react-dom-19.2.0.tgz",
@@ -3481,6 +3535,25 @@
         "react": "^19.2.0"
       }
     },
+    "node_modules/react-google-recaptcha": {
+      "version": "3.1.0",
+      "resolved": "https://registry.npmjs.org/react-google-recaptcha/-/react-google-recaptcha-3.1.0.tgz",
+      "integrity": "sha512-cYW2/DWas8nEKZGD7SCu9BSuVz8iOcOLHChHyi7upUuVhkpkhYG/6N3KDiTQ3XAiZ2UAZkfvYKMfAHOzBOcGEg==",
+      "license": "MIT",
+      "dependencies": {
+        "prop-types": "^15.5.0",
+        "react-async-script": "^1.2.0"
+      },
+      "peerDependencies": {
+        "react": ">=16.4.1"
+      }
+    },
+    "node_modules/react-is": {
+      "version": "16.13.1",
+      "resolved": "https://registry.npmjs.org/react-is/-/react-is-16.13.1.tgz",
+      "integrity": "sha512-24e6ynE2H+OKt4kqsOvNd8kBpV65zoxbA4BVsEOB3ARVWQki/DHzaUoC5KuON/BiccDaCCTZBuOcfZs70kR8bQ==",
+      "license": "MIT"
+    },
     "node_modules/react-refresh": {
       "version": "0.17.0",
       "resolved": "https://registry.npmjs.org/react-refresh/-/react-refresh-0.17.0.tgz",
diff --git a/ipi-survey-platform/package.json b/ipi-survey-platform/package.json
index 0481683..e03f330 100644
--- a/ipi-survey-platform/package.json
+++ b/ipi-survey-platform/package.json
@@ -13,6 +13,7 @@
     "axios": "^1.12.2",
     "react": "^19.1.1",
     "react-dom": "^19.1.1",
+    "react-google-recaptcha": "^3.1.0",
     "react-router-dom": "^7.9.4"
   },
   "devDependencies": {
diff --git a/ipi-survey-platform/src/App.jsx b/ipi-survey-platform/src/App.jsx
index befd636..b44aa1b 100644
--- a/ipi-survey-platform/src/App.jsx
+++ b/ipi-survey-platform/src/App.jsx
@@ -11,6 +11,7 @@ import Login from './pages/Login/Login'
 import History from './pages/History/History'
 import ChangePassword from './pages/ChangePassword/ChangePassword'
 import ForgotPassword from './pages/ForgotPassword/ForgotPassword'
+import PublicContactForm from './pages/PublicContactForm'
 
 const RequireRole = ({ allowedRoles = [], children }) => {
   let role
@@ -102,6 +103,7 @@ function App() {
       />
       <Route path="/change-password" element={<ChangePassword />} />
       <Route path="/forgot-password" element={<ForgotPassword />} />
+      <Route path="/reset-password" element={<PublicContactForm />} />
       <Route path="*" element={<Navigate to="/" replace />} />
     </Routes>
   )
diff --git a/ipi-survey-platform/src/components/admin/AdminHeader.jsx b/ipi-survey-platform/src/components/admin/AdminHeader.jsx
index 33ffd05..bc3c62a 100644
--- a/ipi-survey-platform/src/components/admin/AdminHeader.jsx
+++ b/ipi-survey-platform/src/components/admin/AdminHeader.jsx
@@ -110,7 +110,7 @@ const AdminHeader = () => {
                     className="w-full px-4 py-2.5 text-center text-sm text-[#232528] hover:bg-[#F2ECCF]"
                     onClick={() => {
                       setProfileOpen(false);
-                      navigate('/change-password');
+                      navigate('/reset-password');
                     }}
                   >
                     Change Password
diff --git a/ipi-survey-platform/src/pages/Login/Login.jsx b/ipi-survey-platform/src/pages/Login/Login.jsx
index 821590d..abfc25b 100644
--- a/ipi-survey-platform/src/pages/Login/Login.jsx
+++ b/ipi-survey-platform/src/pages/Login/Login.jsx
@@ -302,7 +302,7 @@ const Login = () => {
               <button
                 type="button"
                 className="text-[#92722A] hover:underline cursor-pointer"
-                onClick={() => navigate('/forgot-password')}
+                onClick={() => navigate('/reset-password')}
               >
                 Forgot password?
               </button>
diff --git a/ipi-survey-platform/src/pages/PublicContactForm.jsx b/ipi-survey-platform/src/pages/PublicContactForm.jsx
new file mode 100644
index 0000000..ec64fac
--- /dev/null
+++ b/ipi-survey-platform/src/pages/PublicContactForm.jsx
@@ -0,0 +1,316 @@
+import React, { useState, useEffect } from "react";
+import Logo from "../assets/images/FCSCLogo.svg";
+import { useNavigate } from "react-router-dom";
+import apiClient from "../services/api/apiClient.js";
+
+const PublicContactForm = () => {
+  const navigate = useNavigate();
+
+  const [formData, setFormData] = useState({
+    establishmentName: "",
+    establishmentId: "",
+    email: "",
+    contactName: "",
+    contactPhone: "",
+    notes: "",
+  });
+
+  const [errors, setErrors] = useState({});
+  const [isValid, setIsValid] = useState(false);
+  const [captcha, setCaptcha] = useState("");
+  const [userCaptcha, setUserCaptcha] = useState("");
+  const [captchaError, setCaptchaError] = useState("");
+  const [loading, setLoading] = useState(false);
+  const [success, setSuccess] = useState("");
+  const [errorMsg, setErrorMsg] = useState("");
+
+  // Generate simple CAPTCHA code
+  const generateCaptcha = () => {
+    const chars = "ABCDEFGHJKLMNPQRSTUVWXYZ23456789";
+    let code = "";
+    for (let i = 0; i < 6; i++) {
+      code += chars.charAt(Math.floor(Math.random() * chars.length));
+    }
+    setCaptcha(code);
+  };
+
+  useEffect(() => {
+    generateCaptcha();
+  }, []);
+
+  // Validation rules
+  const validate = (data = formData) => {
+    const newErrors = {};
+
+    if (!data.establishmentName.trim()) newErrors.establishmentName = "Establishment Name is required.";
+    if (!data.email.trim()) newErrors.email = "Registered Email is required.";
+    else if (!/^[^\s@]+@[^\s@]+\.[^\s@]+$/.test(data.email)) newErrors.email = "Enter a valid email address.";
+    if (!data.contactName.trim()) newErrors.contactName = "Contact Person Name is required.";
+    if (!data.contactPhone.trim()) {
+        newErrors.contactPhone = "Contact Phone is required.";
+      } else if (!/^\d{10,12}$/.test(data.contactPhone)) {
+        newErrors.contactPhone = "Enter a valid phone number (10–12 digits).";
+      }          
+    setErrors(newErrors);
+    setIsValid(Object.keys(newErrors).length === 0);
+    return newErrors;
+  };
+
+  // Restrict Contact Name: only letters and spaces
+const handleNameChange = (e) => {
+    const { value } = e.target;
+    const filtered = value.replace(/[^A-Za-z\s]/g, ""); // remove numbers/special chars
+    setFormData((prev) => ({ ...prev, contactName: filtered }));
+    validate({ ...formData, contactName: filtered });
+  };
+  
+  const handlePhoneChange = (e) => {
+    let { value } = e.target;
+  
+    // Allow only numbers
+    value = value.replace(/\D/g, ""); // remove all non-numeric characters
+  
+    // Limit to 12 digits
+    if (value.length > 12) value = value.slice(0, 12);
+  
+    setFormData((prev) => ({ ...prev, contactPhone: value }));
+    validate({ ...formData, contactPhone: value });
+  };
+  
+  const handleChange = (e) => {
+    const { name, value } = e.target;
+    const updated = { ...formData, [name]: value };
+    setFormData(updated);
+    validate(updated);
+  };
+
+  // CAPTCHA validation
+  const handleCaptchaChange = (e) => {
+    setUserCaptcha(e.target.value.toUpperCase());
+    setCaptchaError("");
+  };
+
+  // Form submit
+  const handleSubmit = async (e) => {
+    e.preventDefault();
+    setErrorMsg("");
+    setSuccess("");
+  
+    const validationErrors = validate();
+    if (Object.keys(validationErrors).length > 0) return;
+  
+    if (userCaptcha !== captcha) {
+      setCaptchaError("Incorrect CAPTCHA. Please try again.");
+      generateCaptcha();
+      return;
+    }
+  
+    // Simulate processing
+    setLoading(true);
+    setTimeout(() => {
+      setLoading(false);
+  
+      // ✅ Show success toast/message
+      setSuccess("Reset Password request successful.");
+  
+      // ✅ Clear fields and regenerate CAPTCHA
+      setFormData({
+        establishmentName: "",
+        establishmentId: "",
+        email: "",
+        contactName: "",
+        contactPhone: "",
+        notes: "",
+      });
+      setUserCaptcha("");
+      generateCaptcha();
+  
+      // ✅ After 3 seconds → clear session + route to login
+      setTimeout(() => {
+        try {
+          sessionStorage.removeItem("auth_token");
+          sessionStorage.removeItem("user_profile");
+          sessionStorage.removeItem("user_role");
+          sessionStorage.removeItem("establishment_id");
+        } catch {
+          // ignore storage errors
+        }
+        navigate("/login");
+      }, 3000);
+    }, 1000); // small delay to simulate "submitting"
+  };
+  
+
+  return (
+    <div className="min-h-screen bg-[#F7F7F7] flex items-center justify-center px-4">
+      <div className="w-full max-w-md">
+        <div className="bg-white rounded-lg shadow-sm ring-1 ring-gray-200 overflow-hidden">
+          {/* Header */}
+          <div className="px-7 py-8 border-b border-gray-200 bg-[#F2ECCF] text-center">
+            <img src={Logo} alt="FCSC" className="w-[188px] h-[58px] mx-auto mb-2" />
+            <h1 className="text-base font-semibold text-[#92722A]">
+              Contact Establishment Info
+            </h1>
+            <p className="mt-1 text-sm text-gray-600">
+              Provide details to contact your establishment.
+            </p>
+          </div>
+
+          <form onSubmit={handleSubmit} className="px-7 py-8 space-y-4">
+            {errorMsg && (
+              <div className="text-sm text-red-700 bg-red-50 border border-red-200 rounded px-3 py-2">
+                {errorMsg}
+              </div>
+            )}
+            {success && (
+              <div className="text-sm text-green-700 bg-green-50 border border-green-200 rounded px-3 py-2">
+                {success}
+              </div>
+            )}
+
+            {/* Inputs */}
+            <InputField
+              label="Establishment Name"
+              name="establishmentName"
+              required
+              value={formData.establishmentName}
+              onChange={handleChange}
+              error={errors.establishmentName}
+            />
+            <InputField
+              label="Establishment ID (if known)"
+              name="establishmentId"
+              value={formData.establishmentId}
+              onChange={handleChange}
+            />
+            <InputField
+              label="Registered Email"
+              name="email"
+              type="email"
+              required
+              value={formData.email}
+              onChange={handleChange}
+              error={errors.email}
+            />
+            <InputField
+              label="Contact Person Name"
+              name="contactName"
+              required
+              value={formData.contactName}
+              onChange={handleNameChange} // ✅ new handler
+              error={errors.contactName}
+            />
+           <InputField
+  label="Contact Phone"
+  name="contactPhone"
+  value={formData.contactPhone}
+  onChange={handlePhoneChange}
+  error={errors.contactPhone}
+  placeholder="Enter phone number"
+  maxLength={12} // extra safeguard
+/>
+
+            {/* Notes */}
+            <div>
+              <label className="block text-sm font-medium text-gray-700 mb-1">
+                Additional Notes
+              </label>
+              <textarea
+                name="notes"
+                rows="3"
+                value={formData.notes}
+                onChange={handleChange}
+                className="block w-full rounded-md border-2 border-[#92722A] focus:border-[#92722A] focus:ring-0 px-4 py-2 text-sm bg-white"
+              ></textarea>
+            </div>
+
+            {/* CAPTCHA */}
+            <div className="mt-4">
+              <label className="block text-sm font-medium text-gray-700 mb-1">
+                CAPTCHA Verification <span className="text-red-500">*</span>
+              </label>
+              <div className="flex items-center gap-3">
+                <div
+                  className="flex justify-center items-center font-mono text-lg tracking-widest bg-gray-100 border-2 border-[#92722A] rounded-md px-4 py-2 select-none"
+                  aria-hidden="true"
+                >
+                  {captcha}
+                </div>
+                <button
+                  type="button"
+                  onClick={generateCaptcha}
+                  className="text-sm text-[#92722A] hover:underline"
+                >
+                  Refresh
+                </button>
+              </div>
+
+              {/* Accessible alternative */}
+              <p className="text-xs text-gray-500 mt-1">
+                If you cannot read the code, click "Refresh" or type the following:{" "}
+                <span className="font-mono">{captcha}</span>
+              </p>
+
+              <input
+                type="text"
+                name="captcha"
+                value={userCaptcha}
+                onChange={handleCaptchaChange}
+                placeholder="Enter the code shown above"
+                className={`mt-2 block w-full h-10 rounded-md border-2 ${
+                  captchaError ? "border-red-500" : "border-[#92722A]"
+                } focus:border-[#92722A] focus:ring-0 px-4 text-sm bg-white`}
+              />
+              {captchaError && (
+                <p className="text-xs text-red-600 mt-1">{captchaError}</p>
+              )}
+            </div>
+
+            {/* Submit */}
+            <button
+              type="submit"
+              disabled={!isValid || loading || !userCaptcha}
+              className={`inline-flex items-center justify-center w-full h-12 rounded-lg text-white ${
+                !isValid || loading || !userCaptcha
+                  ? "bg-[#bfa06a] cursor-not-allowed"
+                  : "bg-[#92722A] hover:bg-[#7b5c1f]"
+              } transition-colors`}
+            >
+              {loading ? "Submitting…" : "Submit"}
+            </button>
+
+            <button
+              type="button"
+              onClick={() => navigate(-1)}
+              className="w-full h-10 rounded-md border border-[#92722A] text-[#92722A] hover:bg-[#92722A]/10 text-sm"
+            >
+              Cancel
+            </button>
+          </form>
+        </div>
+      </div>
+    </div>
+  );
+};
+
+// Input component
+const InputField = ({ label, name, value, onChange, placeholder, required, error, type = "text" }) => (
+  <div>
+    <label className="block text-sm font-medium text-gray-700 mb-1">
+      {label} {required && <span className="text-red-500">*</span>}
+    </label>
+    <input
+      type={type}
+      name={name}
+      value={value}
+      onChange={onChange}
+      placeholder={placeholder}
+      className={`block w-full h-10 rounded-md border-2 ${
+        error ? "border-red-500" : "border-[#92722A]"
+      } focus:border-[#92722A] focus:ring-0 px-4 text-sm bg-white`}
+    />
+    {error && <p className="text-xs text-red-600 mt-1">{error}</p>}
+  </div>
+);
+
+export default PublicContactForm;
\ No newline at end of file