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Candida Questionnaire and Score Sheet
Name: _________________________________________________ Age: _________ The questionnaire is designed for adults and the scoring system isn't appropriate for children. It lists factors in your medical history which promote the growth of Candida Albicans (Section A), and symptoms commonly found in individuals with yeast-connected illness (Sections B and C). For each "Yes" answer in Section A, circle the point score in that section. Record your total score in the box at the end of the section. Then move on to Sections B and C and score as directed. Filling out and scoring this questionaire should help you and your doctor evaluate the possible role of Candida in contributing to your health problems. Yet it will not provide an automatic "Yes" or "No" answer. Section A: History 1. Have you taken tetracyclines (Symycin, Panmycin, Vibramycin, Minocin, etc.) or other antibiotics for acne for one month or longer? ........ 25 2. Have you, at any time in your life, taken other "broad spectrum" antiobiotics* for respiratory, urinary or other infections for 2 months or longer or in shorter courses 4 or more times in a 1-year period? ........ 20 3. Have you taken a broad spectrum antiobiotic* -- even in a single course? ........ 6 4. Have you, at anytime in your life, been bothered by persistant prostatitis, vaginitis, or other problems affecting your reproductive organs? ........ 25
5. Have been pregnant ..
* Including Keflex, ampicillin, amoxicillin, Ceclor, Bactrim, and Septra. Such antibiotics kill off "good germs" while they are killing off those which cause infection.
6. Have you taken birth
control pills ...
7. Have you taken
Prednisone, Decadron or other cortisone-type drugs ...
8. Does exposure to
perfumes, insecticides, fabric shop odors, and other chemicals provoke
... Moderate to severe symptoms? ........ 20 9. Are your symptoms worse on damp, muggy days or in moldy places? ........ 20
10. Have you had athlete's
foot, ring worm, jock itch, or other chronic fungus infections of the skin or
nails? 11. Do you crave sugar? ........ 10 12. Do you crave breads? ........ 10 13. Do you crave alcoholic beverages? ........ 10 14. Does tobacco smoke really bother you? ......... 10 Section B: Major Symptoms For each of your symptoms, enter the appropriate figure in the point score column: Occassional or Mild 3 points Frequent and/or Moderately Severe 6 points Severe and/or Disabling 9 points Add total score and record it in the box at the end of this section: Point Score Point Score 1. Fatigue or lethargy _______ 13. Bloating _______ 2. Feeling of being "drained" _______ 14. Troublesome vaginal discharge _______ 3. Poor memory _______ 15. Persistent vaginal burning or itching ______ 4. Feeling "spacey" or "unreal" _______ 16. Prostatitis _______ 5. Depression _______ 17. Impotence _______ 6. Numbness, burning, or tingling _______ 18. Loss of sexual desire _______ 7. Muscle aches _______ 19. Endometriosis _______ 8. Muscle weakness or paralysis _______ 20. Cramps and/or other menstrual 9. Pain and/or swelling in joints _______ irregularities _______ 10. Abdominal pain _______ 21. Premenstrual tension _______ 11. Constipation _______ 22. Spots in front of the eyes _______ 12. Diarrhea _______ 23. Erratic vision _______ Section C: Other Symptoms For each of your symptoms, enter the appropriate figure in the point score column: Occassional or Mild 1 point Frequent and/or Moderately Severe 2 points Severe and/or Disabling 3 points Add total score and record it in the box at the end of this section: Point Score Point Score 1. Drowsiness _______ 17. Rash or blister in mouth _______ 2. Irritability or jitteriness _______ 18. Bad breath _______ 3. Incoordination _______ 19. Joint swelling or arthritis _______ 4. Inability to concentrate _______ 20. Nasal congestion or discharge _______ 5. Frequent mood swings _______ 21. Postnasal drip _______ 6. Headache _______ 22. Nasal itching _______ 7. Dizziness/loss of balance _______ 23. Sore or dry throat _______ 8. Pressure above ears, feeling of 24. Cough _______ head swelling and tingling _______ 25. Pain or tightness in chest _______ 9. Itching _______ 26. Wheezing or shortness of breath _______ 10. Other rashes _______ 27. Urinary urgency or frequency _______ 11. Heartburn _______ 28. Burning or tearing of eyes _______ 12. Indigestion _______ 29. Failing vision _______ 13. Belching and intestinal gas _______ 30. Burning on urination _______ 14. Mucus in stools _______ 31. Recurrent infections or fluid in ears_______ 15. Hemorrhoids _______ 32. Ear pain or deafness _______ 16. Dry mouth _______
Total Score, Section C _______ Total Score, Section A _______ Total Score, Section B _______ GRAND TOTAL SCORE _______ The Grand Total Score will help you and your doctor decide if your health problems are yeast-connected. Scores in women will run higher as 7 items in the questionaire apply exclusively to women, while only 2 apply exclusively to men. If your score is: Symptoms are: 180 (women) Almost Certainly 140 (men) Yeast Connected 120 (women) Probably 90 (men) Yeast Connected 60 (women) Possibly 40 (men) Yeast Connected
Less Than: 60 (women) Probably Not 40 (men) Yeast Connected
For a Holistic Candida Diet see our Candida Diet Page.
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