AusCal Diet Questionnaire

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Research / Study ID

First two characters of surname + 6 digit DOB

BE140355

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Height

in (cm)

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Weight

in (kg)

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Are you male or female?*

Male

Female

Are you older than 50 years of age?*

How old are you?

Yes

Are you older than 70 years of age?*

How old are you?

Yes

Your recommended RDI intake of calcium

Recommended mg of calcium per day

0 mg of calcium per day

Your recommended RDI intake of calcium

Recommended mg of calcium per day

0 mg of calcium per day

Do you take a calcium supplement?*

Yes

Name or Brand

of supplement

Write here

Approximate mg*

50 (mg) increments

50 mgs

Approx how many tablets per week*

Daily (7), one tablet twice a week (3), once a week (1), two a day (14)

1 serves

Sub Total Supplement

Your Grand Total Calcium (mg) Per Day

(mg) per day

Other Minor Foods

If you eat a full serving (see blue text for serve size) of any of the following on a weekly basis, slide the slider to the right to indicate number of serves per WEEK.

For example, if you eat a banana 7 days a week (every day), most days of the year, slide the slider 7 notches.

If you eat chick-peas every 2nd day, year round, slide the slider 3 notches.

Don’t be confused by the value that appears under the slider. It represents milligrams of calcium not serve number.

Chick Peas*

1/2 half a cup

0 (mg)

Split Peas*

1/2 half a cup

0 (mg)

Couscous*

1/2 half a cup

0 (mg)

Lentils*

1/2 half a cup

0 (mg)

Oat Bran Muffin*

1 muffin

0 (mg)

White Cake*

1 slice

0 (mg)

Cocoa or other chocolate drink powder*

1 tsp

0 (mg)

White Chocolate*

1 piece

0 (mg)

Almonds*

1 handful (10 almonds)

0 (mg)

Brazil Nuts*

1 handful = 2 brazil nuts

0 (mg)

Hazelnuts*

1 handful (10)

0 (mg)

Walnuts*

1 handful (6 walnuts)

0 (mg)

Macadamias*

1 handful (6 nuts)

0 (mg)

Cashews*

1 handful (14)

0 (mg)

Peanuts*

1 handful (20)

0 (mg)

Mixed Nuts*

1 handful (15)

0 (mg)

Peanut Paste*

1 tbsp

0 (mg)

Canned Tuna*

1 can drained

0 (mg)

Prawns*

1 serve (12)

0 (mg)

Scallops*

1 serve

0 (mg)

Oysters*

1 oyster

0 (mg)

Mustard*

1 tsp

0 (mg)

Parsley*

1 pinch

0 (mg)

Soy Sauce*

1 tbsp

0 (mg)

Tomato Sauce*

1 tbsp

0 (mg)

Celery*

1 medium stalk

0 (mg)

Asparagus*

1 spear

0 (mg)

Cauliflower*

3 medium florets

0 (mg)

Pumpkin*

50 grams

0 (mg)

Olives*

1 serve

0 (mg)

Chili*

1 tsp

0 (mg)

Vegetable Juice*

1 cup

0 (mg)

Rhubarb*

50 grams

0 (mg)

Grapes*

50 grams

0 (mg)

Banana*

1 medium

0 (mg)

Pear*

1 medium

0 (mg)

Grapefruit*

1 medium

0 (mg)

Peach*

1 medium

0 (mg)

Dried Apricots*

3 fruits

0 (mg)

Pineapple*

1 cup

0 (mg)

Watermelon*

1 cup

0 (mg)

Rockmelon*

1 cup

0 (mg)

Pawpaw*

1 cup

0 (mg)

Other Notes

Dietitian specific

Write here

Total calcium from other foods

(adds up weekly value and divides by 7) = daily

Total mg daily (including other foods)

For female - are you over or under your calcium RDI?

If negative - you need to eat more calcium per day

For male - are you over or under your calcium RDI?

If negative - you need to eat more calcium per day

The Bone Clinic's Calcium Calculator for Australians

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Other Minor Foods

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