diff --git a/src/components/ageAssurance/AgeAssuranceAccountCard.tsx b/src/components/ageAssurance/AgeAssuranceAccountCard.tsx
index 42c9fa8a74..cccf385692 100644
--- a/src/components/ageAssurance/AgeAssuranceAccountCard.tsx
+++ b/src/components/ageAssurance/AgeAssuranceAccountCard.tsx
@@ -6,6 +6,7 @@ import {useGetTimeAgo} from '#/lib/hooks/useTimeAgo'
 import {useAgeAssuranceContext} from '#/state/age-assurance'
 import {atoms as a, useBreakpoints, useTheme, type ViewStyleProp} from '#/alf'
 import {Admonition} from '#/components/Admonition'
+import {AgeAssuranceAppealDialog} from '#/components/ageAssurance/AgeAssuranceAppealDialog'
 import {AgeAssuranceBadge} from '#/components/ageAssurance/AgeAssuranceBadge'
 import {
   AgeAssuranceInitDialog,
@@ -13,6 +14,8 @@ import {
 } from '#/components/ageAssurance/AgeAssuranceInitDialog'
 import {IsAgeRestricted} from '#/components/ageAssurance/IsAgeRestricted'
 import {Button, ButtonText} from '#/components/Button'
+import * as Dialog from '#/components/Dialog'
+import {createStaticClick, InlineLinkText} from '#/components/Link'
 import {Text} from '#/components/Typography'
 
 export function AgeAssuranceAccountCard({style}: ViewStyleProp & {}) {
@@ -29,6 +32,7 @@ function Inner({style}: ViewStyleProp & {}) {
   const {status, isAgeRestricted, hasInitiated, lastInitiatedAt} =
     useAgeAssuranceContext()
   const control = useDialogControl()
+  const appealControl = Dialog.useDialogControl()
   const getTimeAgo = useGetTimeAgo()
   const {gtPhone} = useBreakpoints()
 
@@ -42,6 +46,7 @@ function Inner({style}: ViewStyleProp & {}) {
   return (
     <>
       <AgeAssuranceInitDialog control={control} />
+      <AgeAssuranceAppealDialog control={appealControl} />
 
       <View style={style}>
         <View
@@ -80,8 +85,15 @@ function Inner({style}: ViewStyleProp & {}) {
               <Admonition type="warning">
                 <Trans>
                   You are currently unable to access Bluesky's Age Assurance
-                  flow. Please contact our moderation team if you believe this
-                  is an error.
+                  flow. Please{' '}
+                  <InlineLinkText
+                    label={_(msg`Contact our moderation team`)}
+                    {...createStaticClick(() => {
+                      appealControl.open()
+                    })}>
+                    contact our moderation team
+                  </InlineLinkText>{' '}
+                  if you believe this is an error.
                 </Trans>
               </Admonition>
             </View>
diff --git a/src/components/ageAssurance/AgeAssuranceAppealDialog.tsx b/src/components/ageAssurance/AgeAssuranceAppealDialog.tsx
new file mode 100644
index 0000000000..2d20f3667f
--- /dev/null
+++ b/src/components/ageAssurance/AgeAssuranceAppealDialog.tsx
@@ -0,0 +1,142 @@
+import React from 'react'
+import {View} from 'react-native'
+import {BSKY_LABELER_DID, ComAtprotoModerationDefs} from '@atproto/api'
+import {msg, Trans} from '@lingui/macro'
+import {useLingui} from '@lingui/react'
+import {useMutation} from '@tanstack/react-query'
+
+import {logger} from '#/logger'
+import {useAgent, useSession} from '#/state/session'
+import * as Toast from '#/view/com/util/Toast'
+import {atoms as a, useBreakpoints, web} from '#/alf'
+import {AgeAssuranceBadge} from '#/components/ageAssurance/AgeAssuranceBadge'
+import {Button, ButtonIcon, ButtonText} from '#/components/Button'
+import * as Dialog from '#/components/Dialog'
+import {Loader} from '#/components/Loader'
+import {Text} from '#/components/Typography'
+
+export function AgeAssuranceAppealDialog({
+  control,
+}: {
+  control: Dialog.DialogControlProps
+}) {
+  const {_} = useLingui()
+  return (
+    <Dialog.Outer control={control}>
+      <Dialog.Handle />
+      <Dialog.ScrollableInner
+        label={_(msg`Contact our moderation team`)}
+        style={[web({maxWidth: 400})]}>
+        <Inner control={control} />
+        <Dialog.Close />
+      </Dialog.ScrollableInner>
+    </Dialog.Outer>
+  )
+}
+
+function Inner({control}: {control: Dialog.DialogControlProps}) {
+  const {_} = useLingui()
+  const {currentAccount} = useSession()
+  const {gtPhone} = useBreakpoints()
+  const agent = useAgent()
+
+  const [details, setDetails] = React.useState('')
+  const isInvalid = details.length > 1000
+
+  const {mutate, isPending} = useMutation({
+    mutationFn: async () => {
+      await agent.createModerationReport(
+        {
+          reasonType: ComAtprotoModerationDefs.REASONAPPEAL,
+          subject: {
+            $type: 'com.atproto.admin.defs#repoRef',
+            did: currentAccount?.did,
+          },
+          reason: `AGE_ASSURANCE_INQUIRY: ` + details,
+        },
+        {
+          encoding: 'application/json',
+          headers: {
+            'atproto-proxy': `${BSKY_LABELER_DID}#atproto_labeler`,
+          },
+        },
+      )
+    },
+    onError: err => {
+      logger.error('AgeAssuranceAppealDialog failed', {safeMessage: err})
+      Toast.show(
+        _(msg`Age assurance inquiry failed to send, please try again.`),
+        'xmark',
+      )
+    },
+    onSuccess: () => {
+      control.close()
+      Toast.show(
+        _(
+          msg({
+            message: 'Age assurance inquiry was submitted',
+            context: 'toast',
+          }),
+        ),
+      )
+    },
+  })
+
+  const onSubmit = React.useCallback(() => mutate(), [mutate])
+
+  return (
+    <View>
+      <View style={[a.align_start]}>
+        <AgeAssuranceBadge />
+      </View>
+
+      <Text style={[a.text_2xl, a.font_heavy, a.pt_md, a.leading_tight]}>
+        <Trans>Contact us</Trans>
+      </Text>
+
+      <Text style={[a.text_sm, a.pt_sm, a.leading_snug]}>
+        <Trans>
+          Please provide any additional details you feel moderators may need in
+          order to properly assess your Age Assurance status.
+        </Trans>
+      </Text>
+
+      <View style={[a.pt_md]}>
+        <Dialog.Input
+          multiline
+          isInvalid={isInvalid}
+          value={details}
+          onChangeText={details => {
+            setDetails(details)
+          }}
+          label={_(msg`Additional details (limit 1000 characters)`)}
+          numberOfLines={4}
+          onSubmitEditing={onSubmit}
+        />
+        <View style={[a.pt_md, a.gap_sm, gtPhone && [a.flex_row_reverse]]}>
+          <Button
+            label={_(msg`Submit`)}
+            size="small"
+            variant="solid"
+            color="primary"
+            onPress={onSubmit}>
+            <ButtonText>
+              <Trans>Submit</Trans>
+            </ButtonText>
+            {isPending && <ButtonIcon icon={Loader} position="right" />}
+          </Button>
+          <Button
+            label={_(msg`Cancel`)}
+            size="small"
+            variant="solid"
+            color="secondary"
+            onPress={() => control.close()}>
+            <ButtonText>
+              <Trans>Cancel</Trans>
+            </ButtonText>
+          </Button>
+        </View>
+      </View>
+    </View>
+  )
+}
diff --git a/src/state/age-assurance/index.tsx b/src/state/age-assurance/index.tsx
index e959c69c4f..b7273368f0 100644
--- a/src/state/age-assurance/index.tsx
+++ b/src/state/age-assurance/index.tsx
@@ -65,7 +65,7 @@ export function Provider({children}: {children: React.ReactNode}) {
         //   (() => ({
         //     data: {
         //       lastInitiatedAt: new Date().toISOString(),
-        //       status: 'assured',
+        //       status: 'blocked',
         //     } as AppBskyUnspeccedDefs.AgeAssuranceState,
         //   }))(),
         // )