diff --git a/src/components/dashboard/inquiryPrivacy/privacy-office/RowActions/Forms/ConfirmRequestForm.jsx b/src/components/dashboard/inquiryPrivacy/privacy-office/RowActions/Forms/ConfirmRequestForm.jsx
index 5d0ca86..3f090fb 100644
--- a/src/components/dashboard/inquiryPrivacy/privacy-office/RowActions/Forms/ConfirmRequestForm.jsx
+++ b/src/components/dashboard/inquiryPrivacy/privacy-office/RowActions/Forms/ConfirmRequestForm.jsx
@@ -1,3 +1,60 @@
-export default function ConfirmRequestForm({ mutate }) {
-    return <div>ConfirmRequestForm</div>;
+import { Box, Button, Checkbox, DialogActions, FormControlLabel, TextField } from "@mui/material";
+import { useState } from "react";
+import { Controller, useForm } from "react-hook-form";
+
+export default function ConfirmRequestForm({ mutate, onClose }) {
+    const [isSubmitting, setIsSubmitting] = useState(false);
+    const { control, handleSubmit } = useForm({
+        defaultValues: {
+            expert_description: "",
+            need_payment: false,
+            needsAccessRoad: false,
+        },
+    });
+
+    const onSubmit = (data) => {
+        console.log(data);
+        setIsSubmitting(true);
+        mutate();
+        onClose();
+    };
+
+    return (
+        <Box sx={{ display: "flex", flexDirection: "column", mt: 1 }}>
+            <Controller
+                name="expert_description"
+                control={control}
+                render={({ field }) => <TextField {...field} fullWidth multiline minRows={3} label="توضیحات" />}
+            />
+            <Controller
+                name="need_payment"
+                control={control}
+                render={({ field }) => (
+                    <FormControlLabel
+                        control={<Checkbox {...field} checked={field.value} />}
+                        label="نیاز به پرداخت وجه خزانه"
+                    />
+                )}
+            />
+            <Controller
+                name="needsAccessRoad"
+                control={control}
+                render={({ field }) => (
+                    <FormControlLabel
+                        control={<Checkbox {...field} checked={field.value} />}
+                        label="نیاز به پرداخت وجه خزانه"
+                    />
+                )}
+            />
+
+            <DialogActions>
+                <Button onClick={onClose} variant="outlined" disabled={isSubmitting}>
+                    انصراف
+                </Button>
+                <Button variant="contained" onClick={handleSubmit(onSubmit)} disabled={isSubmitting}>
+                    انجام عملیات
+                </Button>
+            </DialogActions>
+        </Box>
+    );
 }