Enrolment Form | Menopause Momentum N

First name

Last name

Email

Phone

What is your current weight and height?

What is your weight loss goal for the next 10 days? (e.g., lose 2 kg, reduce bloating, fit into a certain outfit)

Are you currently on HRT or any medications/supplements? If yes, please list.

Yes

No

If yes, please list down

If you have MCAS or histamine-related symptoms, a low-histamine diet is essential. Are you willing to follow one for the 10 days?

Yes

No

Signature Dish Challenge: If you have MCAS or histamine problems, we’ll invite you to submit your favourite signature dish. As a group, we’ll work together to transform it into a delicious, low-histamine version you’ll love—so you never feel deprived.

I’m in — let’s cook!