diff --git a/CHANGELOG.md b/CHANGELOG.md
index 0d7275947..a092fa79e 100644
--- a/CHANGELOG.md
+++ b/CHANGELOG.md
@@ -35,6 +35,16 @@
   });
   ```
 
+- User Feedback Form Component Beta ([#4320](https://github.com/getsentry/sentry-react-native/pull/4328))
+
+   To collect user feedback from inside your application add the `FeedbackForm` component.
+
+  ```jsx
+  import { FeedbackForm } from "@sentry/react-native";
+  ...
+  <FeedbackForm/>
+  ```
+
 - Export `Span` type from `@sentry/types` ([#4345](https://github.com/getsentry/sentry-react-native/pull/4345))
 
 ### Fixes
diff --git a/packages/core/src/js/feedback/FeedbackForm.styles.ts b/packages/core/src/js/feedback/FeedbackForm.styles.ts
new file mode 100644
index 000000000..0ab35584d
--- /dev/null
+++ b/packages/core/src/js/feedback/FeedbackForm.styles.ts
@@ -0,0 +1,62 @@
+import type { FeedbackFormStyles } from './FeedbackForm.types';
+
+const PURPLE = 'rgba(88, 74, 192, 1)';
+const FORGROUND_COLOR = '#2b2233';
+const BACKROUND_COLOR = '#fff';
+const BORDER_COLOR = 'rgba(41, 35, 47, 0.13)';
+
+const defaultStyles: FeedbackFormStyles = {
+  container: {
+    flex: 1,
+    padding: 20,
+    backgroundColor: BACKROUND_COLOR,
+  },
+  title: {
+    fontSize: 24,
+    fontWeight: 'bold',
+    marginBottom: 20,
+    textAlign: 'center',
+    color: FORGROUND_COLOR,
+  },
+  label: {
+    marginBottom: 4,
+    fontSize: 16,
+    color: FORGROUND_COLOR,
+  },
+  input: {
+    height: 50,
+    borderColor: BORDER_COLOR,
+    borderWidth: 1,
+    borderRadius: 5,
+    paddingHorizontal: 10,
+    marginBottom: 15,
+    fontSize: 16,
+    color: FORGROUND_COLOR,
+  },
+  textArea: {
+    height: 100,
+    textAlignVertical: 'top',
+    color: FORGROUND_COLOR,
+  },
+  submitButton: {
+    backgroundColor: PURPLE,
+    paddingVertical: 15,
+    borderRadius: 5,
+    alignItems: 'center',
+    marginBottom: 10,
+  },
+  submitText: {
+    color: BACKROUND_COLOR,
+    fontSize: 18,
+  },
+  cancelButton: {
+    paddingVertical: 15,
+    alignItems: 'center',
+  },
+  cancelText: {
+    color: FORGROUND_COLOR,
+    fontSize: 16,
+  },
+};
+
+export default defaultStyles;
diff --git a/packages/core/src/js/feedback/FeedbackForm.tsx b/packages/core/src/js/feedback/FeedbackForm.tsx
new file mode 100644
index 000000000..c978db83e
--- /dev/null
+++ b/packages/core/src/js/feedback/FeedbackForm.tsx
@@ -0,0 +1,170 @@
+import { captureFeedback, getCurrentScope, lastEventId } from '@sentry/core';
+import type { SendFeedbackParams } from '@sentry/types';
+import * as React from 'react';
+import type { KeyboardTypeOptions } from 'react-native';
+import {
+  Alert,
+  Keyboard,
+  KeyboardAvoidingView,
+  SafeAreaView,
+  ScrollView,
+  Text,
+  TextInput,
+  TouchableOpacity,
+  TouchableWithoutFeedback,
+  View
+} from 'react-native';
+
+import { defaultConfiguration } from './defaults';
+import defaultStyles from './FeedbackForm.styles';
+import type { FeedbackFormProps, FeedbackFormState, FeedbackFormStyles,FeedbackGeneralConfiguration, FeedbackTextConfiguration } from './FeedbackForm.types';
+
+/**
+ * @beta
+ * Implements a feedback form screen that sends feedback to Sentry using Sentry.captureFeedback.
+ */
+export class FeedbackForm extends React.Component<FeedbackFormProps, FeedbackFormState> {
+  private _config: FeedbackFormProps;
+
+  public constructor(props: FeedbackFormProps) {
+    super(props);
+
+    const currentUser = {
+      useSentryUser: {
+        email: getCurrentScope().getUser().email || '',
+        name: getCurrentScope().getUser().name || '',
+      }
+    }
+
+    this._config = { ...defaultConfiguration, ...currentUser, ...props };
+    this.state = {
+      isVisible: true,
+      name: this._config.useSentryUser.name,
+      email: this._config.useSentryUser.email,
+      description: '',
+    };
+  }
+
+  public handleFeedbackSubmit: () => void = () => {
+    const { name, email, description } = this.state;
+    const { onFormClose } = this._config;
+    const text: FeedbackTextConfiguration = this._config;
+
+    const trimmedName = name?.trim();
+    const trimmedEmail = email?.trim();
+    const trimmedDescription = description?.trim();
+
+    if ((this._config.isNameRequired && !trimmedName) || (this._config.isEmailRequired && !trimmedEmail) || !trimmedDescription) {
+      Alert.alert(text.errorTitle, text.formError);
+      return;
+    }
+
+    if (this._config.shouldValidateEmail && (this._config.isEmailRequired || trimmedEmail.length > 0) && !this._isValidEmail(trimmedEmail)) {
+      Alert.alert(text.errorTitle, text.emailError);
+      return;
+    }
+
+    const eventId = lastEventId();
+    const userFeedback: SendFeedbackParams = {
+      message: trimmedDescription,
+      name: trimmedName,
+      email: trimmedEmail,
+      associatedEventId: eventId,
+    };
+
+    onFormClose();
+    this.setState({ isVisible: false });
+
+    captureFeedback(userFeedback);
+    Alert.alert(text.successMessageText);
+  };
+
+  /**
+   * Renders the feedback form screen.
+   */
+  public render(): React.ReactNode {
+    const { name, email, description } = this.state;
+    const { onFormClose } = this._config;
+    const config: FeedbackGeneralConfiguration = this._config;
+    const text: FeedbackTextConfiguration = this._config;
+    const styles: FeedbackFormStyles = { ...defaultStyles, ...this.props.styles };
+    const onCancel = (): void => {
+      onFormClose();
+      this.setState({ isVisible: false });
+    }
+
+    if (!this.state.isVisible) {
+      return null;
+    }
+
+    return (
+    <SafeAreaView style={[styles.container, { padding: 0 }]}>
+      <KeyboardAvoidingView behavior={'padding'} style={[styles.container, { padding: 0 }]}>
+        <ScrollView>
+          <TouchableWithoutFeedback onPress={Keyboard.dismiss}>
+            <View style={styles.container}>
+              <Text style={styles.title}>{text.formTitle}</Text>
+
+              {config.showName && (
+              <>
+                <Text style={styles.label}>
+                  {text.nameLabel}
+                  {config.isNameRequired && ` ${text.isRequiredLabel}`}
+                </Text>
+                <TextInput
+                  style={styles.input}
+                  placeholder={text.namePlaceholder}
+                  value={name}
+                  onChangeText={(value) => this.setState({ name: value })}
+                />
+              </>
+              )}
+
+              {config.showEmail && (
+              <>
+                <Text style={styles.label}>
+                  {text.emailLabel}
+                  {config.isEmailRequired && ` ${text.isRequiredLabel}`}
+                </Text>
+                <TextInput
+                  style={styles.input}
+                  placeholder={text.emailPlaceholder}
+                  keyboardType={'email-address' as KeyboardTypeOptions}
+                  value={email}
+                  onChangeText={(value) => this.setState({ email: value })}
+                />
+              </>
+              )}
+
+              <Text style={styles.label}>
+                {text.messageLabel}
+                {` ${text.isRequiredLabel}`}
+              </Text>
+              <TextInput
+                style={[styles.input, styles.textArea]}
+                placeholder={text.messagePlaceholder}
+                value={description}
+                onChangeText={(value) => this.setState({ description: value })}
+                multiline
+              />
+
+              <TouchableOpacity style={styles.submitButton} onPress={this.handleFeedbackSubmit}>
+                <Text style={styles.submitText}>{text.submitButtonLabel}</Text>
+              </TouchableOpacity>
+
+              <TouchableOpacity style={styles.cancelButton} onPress={onCancel}>
+                <Text style={styles.cancelText}>{text.cancelButtonLabel}</Text>
+              </TouchableOpacity>
+            </View>
+          </TouchableWithoutFeedback>
+        </ScrollView>
+      </KeyboardAvoidingView>
+    </SafeAreaView>
+    );
+  }
+
+  private _isValidEmail = (email: string): boolean => {
+    const emailRegex = /^[a-zA-Z0-9._%+-]+@[a-zA-Z0-9.-]+\.[a-zA-Z]{2,}$/
+    return emailRegex.test(email);
+  };
+}
diff --git a/packages/core/src/js/feedback/FeedbackForm.types.ts b/packages/core/src/js/feedback/FeedbackForm.types.ts
new file mode 100644
index 000000000..84078d8a6
--- /dev/null
+++ b/packages/core/src/js/feedback/FeedbackForm.types.ts
@@ -0,0 +1,148 @@
+import type { TextStyle, ViewStyle } from 'react-native';
+
+export interface FeedbackFormProps extends FeedbackGeneralConfiguration, FeedbackTextConfiguration, FeedbackCallbacks {
+  styles?: FeedbackFormStyles;
+}
+
+/**
+ * General feedback configuration
+ */
+export interface FeedbackGeneralConfiguration {
+  /**
+   * Should the email field be required?
+   */
+  isEmailRequired?: boolean;
+
+  /**
+   * Should the email field be validated?
+   */
+  shouldValidateEmail?: boolean;
+
+  /**
+   * Should the name field be required?
+   */
+  isNameRequired?: boolean;
+
+  /**
+   * Should the email input field be visible? Note: email will still be collected if set via `Sentry.setUser()`
+   */
+  showEmail?: boolean;
+
+  /**
+   * Should the name input field be visible? Note: name will still be collected if set via `Sentry.setUser()`
+   */
+  showName?: boolean;
+
+  /**
+   * Fill in email/name input fields with Sentry user context if it exists.
+   * The value of the email/name keys represent the properties of your user context.
+   */
+  useSentryUser?: {
+    email: string;
+    name: string;
+  };
+}
+
+/**
+ * All of the different text labels that can be customized
+ */
+export interface FeedbackTextConfiguration {
+  /**
+   * The label for the Feedback form cancel button that closes dialog
+   */
+  cancelButtonLabel?: string;
+
+  /**
+   * The label for the Feedback form submit button that sends feedback
+   */
+  submitButtonLabel?: string;
+
+  /**
+   * The title of the Feedback form
+   */
+  formTitle?: string;
+
+  /**
+   * Label for the email input
+   */
+  emailLabel?: string;
+
+  /**
+   * Placeholder text for Feedback email input
+   */
+  emailPlaceholder?: string;
+
+  /**
+   * Label for the message input
+   */
+  messageLabel?: string;
+
+  /**
+   * Placeholder text for Feedback message input
+   */
+  messagePlaceholder?: string;
+
+  /**
+   * Label for the name input
+   */
+  nameLabel?: string;
+
+  /**
+   * Message after feedback was sent successfully
+   */
+  successMessageText?: string;
+
+  /**
+   * Placeholder text for Feedback name input
+   */
+  namePlaceholder?: string;
+
+  /**
+   * Text which indicates that a field is required
+   */
+  isRequiredLabel?: string;
+
+  /**
+   * The title of the error dialog
+   */
+  errorTitle?: string;
+
+  /**
+   * The error message when the form is invalid
+   */
+  formError?: string;
+
+  /**
+   * The error message when the email is invalid
+   */
+  emailError?: string;
+}
+
+/**
+ * The public callbacks available for the feedback integration
+ */
+export interface FeedbackCallbacks {
+  /**
+   * Callback when form is closed and not submitted
+   */
+  onFormClose?: () => void;
+}
+
+export interface FeedbackFormStyles {
+  container?: ViewStyle;
+  title?: TextStyle;
+  label?: TextStyle;
+  input?: TextStyle;
+  textArea?: TextStyle;
+  submitButton?: ViewStyle;
+  submitText?: TextStyle;
+  cancelButton?: ViewStyle;
+  cancelText?: TextStyle;
+}
+
+export interface FeedbackFormState {
+  isVisible: boolean;
+  name: string;
+  email: string;
+  description: string;
+}
diff --git a/packages/core/src/js/feedback/defaults.ts b/packages/core/src/js/feedback/defaults.ts
new file mode 100644
index 000000000..ae8a3e957
--- /dev/null
+++ b/packages/core/src/js/feedback/defaults.ts
@@ -0,0 +1,53 @@
+import { Alert } from 'react-native';
+
+import type { FeedbackFormProps } from './FeedbackForm.types';
+
+const FORM_TITLE = 'Report a Bug';
+const NAME_PLACEHOLDER = 'Your Name';
+const NAME_LABEL = 'Name';
+const EMAIL_PLACEHOLDER = 'your.email@example.org';
+const EMAIL_LABEL = 'Email';
+const MESSAGE_PLACEHOLDER = "What's the bug? What did you expect?";
+const MESSAGE_LABEL = 'Description';
+const IS_REQUIRED_LABEL = '(required)';
+const SUBMIT_BUTTON_LABEL = 'Send Bug Report';
+const CANCEL_BUTTON_LABEL = 'Cancel';
+const ERROR_TITLE = 'Error';
+const FORM_ERROR = 'Please fill out all required fields.';
+const EMAIL_ERROR = 'Please enter a valid email address.';
+const SUCCESS_MESSAGE_TEXT = 'Thank you for your report!';
+
+export const defaultConfiguration: Partial<FeedbackFormProps> = {
+  // FeedbackCallbacks
+  onFormClose: () => {
+    if (__DEV__) {
+      Alert.alert(
+        'Development note',
+        'onFormClose callback is not implemented. By default the form is just unmounted.',
+      );
+    }
+  },
+
+  // FeedbackGeneralConfiguration
+  isEmailRequired: false,
+  shouldValidateEmail: true,
+  isNameRequired: false,
+  showEmail: true,
+  showName: true,
+
+  // FeedbackTextConfiguration
+  cancelButtonLabel: CANCEL_BUTTON_LABEL,
+  emailLabel: EMAIL_LABEL,
+  emailPlaceholder: EMAIL_PLACEHOLDER,
+  formTitle: FORM_TITLE,
+  isRequiredLabel: IS_REQUIRED_LABEL,
+  messageLabel: MESSAGE_LABEL,
+  messagePlaceholder: MESSAGE_PLACEHOLDER,
+  nameLabel: NAME_LABEL,
+  namePlaceholder: NAME_PLACEHOLDER,
+  submitButtonLabel: SUBMIT_BUTTON_LABEL,
+  errorTitle: ERROR_TITLE,
+  formError: FORM_ERROR,
+  emailError: EMAIL_ERROR,
+  successMessageText: SUCCESS_MESSAGE_TEXT,
+};
diff --git a/packages/core/src/js/index.ts b/packages/core/src/js/index.ts
index af1c1d985..97775503f 100644
--- a/packages/core/src/js/index.ts
+++ b/packages/core/src/js/index.ts
@@ -84,3 +84,5 @@ export {
 export type { TimeToDisplayProps } from './tracing';
 
 export { Mask, Unmask } from './replay/CustomMask';
+
+export { FeedbackForm } from './feedback/FeedbackForm';
diff --git a/packages/core/test/feedback/FeedbackForm.test.tsx b/packages/core/test/feedback/FeedbackForm.test.tsx
new file mode 100644
index 000000000..272072f41
--- /dev/null
+++ b/packages/core/test/feedback/FeedbackForm.test.tsx
@@ -0,0 +1,149 @@
+import { captureFeedback } from '@sentry/core';
+import { fireEvent, render, waitFor } from '@testing-library/react-native';
+import * as React from 'react';
+import { Alert } from 'react-native';
+
+import { FeedbackForm } from '../../src/js/feedback/FeedbackForm';
+import type { FeedbackFormProps } from '../../src/js/feedback/FeedbackForm.types';
+
+const mockOnFormClose = jest.fn();
+
+jest.spyOn(Alert, 'alert');
+
+jest.mock('@sentry/core', () => ({
+  captureFeedback: jest.fn(),
+  getCurrentScope: jest.fn(() => ({
+    getUser: jest.fn(() => ({
+      email: 'test@example.com',
+      name: 'Test User',
+    })),
+  })),
+  lastEventId: jest.fn(),
+}));
+
+const defaultProps: FeedbackFormProps = {
+  onFormClose: mockOnFormClose,
+  formTitle: 'Feedback Form',
+  nameLabel: 'Name',
+  namePlaceholder: 'Name Placeholder',
+  emailLabel: 'Email',
+  emailPlaceholder: 'Email Placeholder',
+  messageLabel: 'Description',
+  messagePlaceholder: 'Description Placeholder',
+  submitButtonLabel: 'Submit',
+  cancelButtonLabel: 'Cancel',
+  isRequiredLabel: '(required)',
+  errorTitle: 'Error',
+  formError: 'Please fill out all required fields.',
+  emailError: 'The email address is not valid.',
+  successMessageText: 'Feedback success',
+};
+
+describe('FeedbackForm', () => {
+  afterEach(() => {
+    jest.clearAllMocks();
+  });
+
+  it('renders correctly', () => {
+    const { getByPlaceholderText, getByText } = render(<FeedbackForm {...defaultProps} />);
+
+    expect(getByText(defaultProps.formTitle)).toBeTruthy();
+    expect(getByText(defaultProps.nameLabel)).toBeTruthy();
+    expect(getByPlaceholderText(defaultProps.namePlaceholder)).toBeTruthy();
+    expect(getByText(defaultProps.emailLabel)).toBeTruthy();
+    expect(getByPlaceholderText(defaultProps.emailPlaceholder)).toBeTruthy();
+    expect(getByText(`${defaultProps.messageLabel } ${  defaultProps.isRequiredLabel}`)).toBeTruthy();
+    expect(getByPlaceholderText(defaultProps.messagePlaceholder)).toBeTruthy();
+    expect(getByText(defaultProps.submitButtonLabel)).toBeTruthy();
+    expect(getByText(defaultProps.cancelButtonLabel)).toBeTruthy();
+  });
+
+  it('name and email are prefilled when sentry user is set', () => {
+    const { getByPlaceholderText } = render(<FeedbackForm {...defaultProps} />);
+
+    const nameInput = getByPlaceholderText(defaultProps.namePlaceholder);
+    const emailInput = getByPlaceholderText(defaultProps.emailPlaceholder);
+
+    expect(nameInput.props.value).toBe('Test User');
+    expect(emailInput.props.value).toBe('test@example.com');
+  });
+
+  it('shows an error message if required fields are empty', async () => {
+    const { getByText } = render(<FeedbackForm {...defaultProps} />);
+
+    fireEvent.press(getByText(defaultProps.submitButtonLabel));
+
+    await waitFor(() => {
+      expect(Alert.alert).toHaveBeenCalledWith(defaultProps.errorTitle, defaultProps.formError);
+    });
+  });
+
+  it('shows an error message if the email is not valid and the email is required', async () => {
+    const withEmailProps = {...defaultProps, ...{isEmailRequired: true}};
+    const { getByPlaceholderText, getByText } = render(<FeedbackForm {...withEmailProps} />);
+
+    fireEvent.changeText(getByPlaceholderText(defaultProps.namePlaceholder), 'John Doe');
+    fireEvent.changeText(getByPlaceholderText(defaultProps.emailPlaceholder), 'not-an-email');
+    fireEvent.changeText(getByPlaceholderText(defaultProps.messagePlaceholder), 'This is a feedback message.');
+
+    fireEvent.press(getByText(defaultProps.submitButtonLabel));
+
+    await waitFor(() => {
+      expect(Alert.alert).toHaveBeenCalledWith(defaultProps.errorTitle, defaultProps.emailError);
+    });
+  });
+
+  it('calls captureFeedback when the form is submitted successfully', async () => {
+    const { getByPlaceholderText, getByText } = render(<FeedbackForm {...defaultProps} />);
+
+    fireEvent.changeText(getByPlaceholderText(defaultProps.namePlaceholder), 'John Doe');
+    fireEvent.changeText(getByPlaceholderText(defaultProps.emailPlaceholder), 'john.doe@example.com');
+    fireEvent.changeText(getByPlaceholderText(defaultProps.messagePlaceholder), 'This is a feedback message.');
+
+    fireEvent.press(getByText(defaultProps.submitButtonLabel));
+
+    await waitFor(() => {
+      expect(captureFeedback).toHaveBeenCalledWith({
+        message: 'This is a feedback message.',
+        name: 'John Doe',
+        email: 'john.doe@example.com',
+      });
+    });
+  });
+
+  it('shows success message when the form is submitted successfully', async () => {
+    const { getByPlaceholderText, getByText } = render(<FeedbackForm {...defaultProps} />);
+
+    fireEvent.changeText(getByPlaceholderText(defaultProps.namePlaceholder), 'John Doe');
+    fireEvent.changeText(getByPlaceholderText(defaultProps.emailPlaceholder), 'john.doe@example.com');
+    fireEvent.changeText(getByPlaceholderText(defaultProps.messagePlaceholder), 'This is a feedback message.');
+
+    fireEvent.press(getByText(defaultProps.submitButtonLabel));
+
+    await waitFor(() => {
+      expect(Alert.alert).toHaveBeenCalledWith(defaultProps.successMessageText);
+    });
+  });
+
+  it('calls onFormClose when the form is submitted successfully', async () => {
+    const { getByPlaceholderText, getByText } = render(<FeedbackForm {...defaultProps} />);
+
+    fireEvent.changeText(getByPlaceholderText(defaultProps.namePlaceholder), 'John Doe');
+    fireEvent.changeText(getByPlaceholderText(defaultProps.emailPlaceholder), 'john.doe@example.com');
+    fireEvent.changeText(getByPlaceholderText(defaultProps.messagePlaceholder), 'This is a feedback message.');
+
+    fireEvent.press(getByText(defaultProps.submitButtonLabel));
+
+    await waitFor(() => {
+      expect(mockOnFormClose).toHaveBeenCalled();
+    });
+  });
+
+  it('calls onFormClose when the cancel button is pressed', () => {
+    const { getByText } = render(<FeedbackForm {...defaultProps} />);
+
+    fireEvent.press(getByText(defaultProps.cancelButtonLabel));
+
+    expect(mockOnFormClose).toHaveBeenCalled();
+  });
+});
diff --git a/samples/react-native/src/App.tsx b/samples/react-native/src/App.tsx
index 04348fa5c..0e3f0285a 100644
--- a/samples/react-native/src/App.tsx
+++ b/samples/react-native/src/App.tsx
@@ -16,6 +16,7 @@ import Animated, {
 
 // Import the Sentry React Native SDK
 import * as Sentry from '@sentry/react-native';
+import { FeedbackForm } from '@sentry/react-native';
 
 import { SENTRY_INTERNAL_DSN } from './dsn';
 import ErrorsScreen from './Screens/ErrorsScreen';
@@ -151,6 +152,27 @@ const ErrorsTabNavigator = Sentry.withProfiler(
               component={ErrorsScreen}
               options={{ title: 'Errors' }}
             />
+            <Stack.Screen
+              name="FeedbackForm"
+              options={{ presentation: 'modal', headerShown: false }}
+            >
+              {(props) => (
+                <FeedbackForm
+                  {...props}
+                  onFormClose={props.navigation.goBack}
+                  styles={{
+                    submitButton: {
+                      backgroundColor: '#6a1b9a',
+                      paddingVertical: 15,
+                      borderRadius: 5,
+                      alignItems: 'center',
+                      marginBottom: 10,
+                    },
+                  }}
+                  namePlaceholder={'Fullname'}
+                />
+              )}
+            </Stack.Screen>
           </Stack.Navigator>
         </Provider>
       </GestureHandlerRootView>
diff --git a/samples/react-native/src/Screens/ErrorsScreen.tsx b/samples/react-native/src/Screens/ErrorsScreen.tsx
index 5f2f40567..4788fa407 100644
--- a/samples/react-native/src/Screens/ErrorsScreen.tsx
+++ b/samples/react-native/src/Screens/ErrorsScreen.tsx
@@ -220,6 +220,12 @@ const ErrorsScreen = (_props: Props) => {
             }
           }}
         />
+        <Button
+          title="Feedback form"
+          onPress={() => {
+            _props.navigation.navigate('FeedbackForm');
+          }}
+        />
         <Button
           title="Send user feedback"
           onPress={() => {