Tasker is an Android app.
If you do not need the user interface to work with desktop or Apple versions of Memento, and the interface is very important, Tasker might be a solution.
Tasker can create records in Memento, using Memento as a plug-in to Tasker. With Tasker you can create a user interface such as in the example from the original post.
There is an extension to Tasker (App Factory):
This allows creation of stand-alone Android apps, so that other people can use the user interface created in Tasker without having to install Tasker.
If you do not already code Android apps, learning Tasker is easier than learning to code Android apps, but less powerful.