Yeast Questionnaire

This questionnaire lists factors in your medical history that promote the growth of the common yeast, Candida albicans (Section A), and symptoms commonly found in individuals with yeast-connected illness (Sections B and C).

* Filling out and scoring this questionnaire should help you and your physician evaluate how Candida albicans may be contributing to your health problems. Yet it will not provide an automatic Yes or No answer.

Section D: Gender Answer Yes or No by clicking in the circle beside your answer.
Are you male or female?	M F


Your Score:
Results:

The total score will help you and your physician decide if your health problems are yeast-connected. Scores for women will run higher, as 7 items in this questionnaire apply exclusively to women, while only 2 apply exclusively to men.

Yeast-connected health problems are almost certainly present in women with scores over 180, and in men with scores over 140.

Yeast-connected health problems are probably present in women with scores over 120, and in men with scores over 90.

Yeast-connected health problems are possibly present in women with scores over 60, and in men with scores over 40.

With scores less than 60 for women and 40 for men, yeast are less apt to cause health problems.

* Results May Vary

Section A: History Answer Yes or No by clicking in the circle beside your answer.
Have you taken antibiotics for acne for 1 month (or longer)? (Point score - 50)	Yes No
Have you, at any time in your life, taken other "broad spectrum" antibiotics for respiratory, urinary or other infections for 2 months or longer, or for shorter periods 4 or more times in a 1-year span? (Point score - 50)	Yes No
Have you taken a broad spectrum antibiotic drug – even for one period? (Point score - 6)	Yes No
Have you, at any time in your life, been bothered by persistent prostatitis, vaginitis, or other problems affecting your reproductive organs? (Point score - 25)	Yes No
Have you been pregnant 2 or more times? (Point score - 5)	Yes No
Pregnant 1 time? (Point score - 3)	Yes No
Have you taken birth control pills for more than 2 years? (Point score - 15)	Yes No
Taken birth control pills 6 months to 2 years? (Point score - 8)	Yes No
Have you taken cortisone-type drugs by mouth or inhalation for more than 2 weeks? (Point score - 15)	Yes No
Taken these drugs 2 weeks or less? (Point score - 6)	Yes No
Does exposure to perfumes, insecticides, fabric shop odors, or other chemicals provoke moderate to severe symptoms? (Point score - 20)	Yes No
Does exposure produce mild symptoms? (Point score - 5)	Yes No
Are your symptoms worse on damp, muggy days or in moldy places? (Point score - 20)	Yes No
Have you had athlete’s foot, ringworm, "jock itch" or other chronic fungus infections of the skin or nails that have been severe or persistent? (Point score - 20)	Yes No
Mild or moderate? (Point score - 10)	Yes No
Do you crave sugar? (Point score - 10)	Yes No
Do you crave breads? (Point score - 10)	Yes No
Do you crave alcoholic beverages? (Point score - 10)	Yes No
Does tobacco smoke really bother you? (Point score - 10)	Yes No

Section B: Major Symptoms Click in the circle beside your answer. If you haven't experienced any of the symptoms stated in the question, leave it blank. If a symptom is occasional or mild, score 3 points. If a symptom is frequent and/or moderately severe, score 6 points. If a symptom is severe and/or disabling, score 9 points.
Fatigue or lethargy	Occasional/Mild Frequent/Moderate Severe/Disabling
Feeling of being "drained"	Occasional/Mild Frequent/Moderate Severe/Disabling
Poor memory	Occasional/Mild Frequent/Moderate Severe/Disabling
Feeling "spacey" or "unreal"	Occasional/Mild Frequent/Moderate Severe/Disabling
Inability to make decisions	Occasional/Mild Frequent/Moderate Severe/Disabling
Numbness, burning or tingling	Occasional/Mild Frequent/Moderate Severe/Disabling
Insomnia	Occasional/Mild Frequent/Moderate Severe/Disabling
Muscle aches	Occasional/Mild Frequent/Moderate Severe/Disabling
Muscle weakness or paralysis	Occasional/Mild Frequent/Moderate Severe/Disabling
Pain and/or swelling in joints	Occasional/Mild Frequent/Moderate Severe/Disabling
Abdominal pain	Occasional/Mild Frequent/Moderate Severe/Disabling
Constipation	Occasional/Mild Frequent/Moderate Severe/Disabling
Diarrhea	Occasional/Mild Frequent/Moderate Severe/Disabling
Bloating, belching or intestinal gas	Occasional/Mild Frequent/Moderate Severe/Disabling
Troublesome vaginal burning, itching or discharge	Occasional/Mild Frequent/Moderate Severe/Disabling
Prostatitis	Occasional/Mild Frequent/Moderate Severe/Disabling
Impotence	Occasional/Mild Frequent/Moderate Severe/Disabling
Loss of sexual desire or feeling	Occasional/Mild Frequent/Moderate Severe/Disabling
Endometriosis or infertility	Occasional/Mild Frequent/Moderate Severe/Disabling
Cramps and/or other menstrual irregularities	Occasional/Mild Frequent/Moderate Severe/Disabling
Premenstrual tension	Occasional/Mild Frequent/Moderate Severe/Disabling
Attacks of anxiety or crying	Occasional/Mild Frequent/Moderate Severe/Disabling
Cold hands or feet and/or chilliness	Occasional/Mild Frequent/Moderate Severe/Disabling
Shaking or irritable when hungry	Occasional/Mild Frequent/Moderate Severe/Disabling

Section C: Other Symptoms Click in the circle beside your answer. If you haven't experienced any of the symptoms stated in the question, leave it blank. If a symptom is occasional or mild, score 3 points. If a symptom is frequent and/or moderately severe, score 6 points. If a symptom is severe and/or disabling, score 9 points.
Drowsiness	Occasional/Mild Frequent/Moderate Severe/Disabling
Irritability or jitteryness	Occasional/Mild Frequent/Moderate Severe/Disabling
Incoordination	Occasional/Mild Frequent/Moderate Severe/Disabling
Inability to concentrate	Occasional/Mild Frequent/Moderate Severe/Disabling
Frequent mood swings	Occasional/Mild Frequent/Moderate Severe/Disabling
Headaches	Occasional/Mild Frequent/Moderate Severe/Disabling
Dizziness/loss of balance	Occasional/Mild Frequent/Moderate Severe/Disabling
Pressure above ears, feeling of head swelling	Occasional/Mild Frequent/Moderate Severe/Disabling
Tendency to bruise easily	Occasional/Mild Frequent/Moderate Severe/Disabling
Chronic rashes or itching	Occasional/Mild Frequent/Moderate Severe/Disabling
Psoriasis or recurrent hives	Occasional/Mild Frequent/Moderate Severe/Disabling
Indigestion or heartburn	Occasional/Mild Frequent/Moderate Severe/Disabling
Food sensitivity or intolerance	Occasional/Mild Frequent/Moderate Severe/Disabling
Mucus in stools	Occasional/Mild Frequent/Moderate Severe/Disabling
Rectal itching	Occasional/Mild Frequent/Moderate Severe/Disabling
Dry mouth or throat	Occasional/Mild Frequent/Moderate Severe/Disabling
Rash or blisters in mouth	Occasional/Mild Frequent/Moderate Severe/Disabling
Bad breath	Occasional/Mild Frequent/Moderate Severe/Disabling
Foot, hair or body odor not relieved by washing	Occasional/Mild Frequent/Moderate Severe/Disabling
Nasal congestion or post nasal drip	Occasional/Mild Frequent/Moderate Severe/Disabling
Nasal itching	Occasional/Mild Frequent/Moderate Severe/Disabling
Sore throat	Occasional/Mild Frequent/Moderate Severe/Disabling
Laryngitis, loss of voice	Occasional/Mild Frequent/Moderate Severe/Disabling
Cough or recurrent bronchitis	Occasional/Mild Frequent/Moderate Severe/Disabling
Pain or tightness in chest	Occasional/Mild Frequent/Moderate Severe/Disabling
Wheezing or shortness of breath	Occasional/Mild Frequent/Moderate Severe/Disabling
Urinary frequency, urgency or incontinence	Occasional/Mild Frequent/Moderate Severe/Disabling
Burning on urination	Occasional/Mild Frequent/Moderate Severe/Disabling
Spots in front of eyes or erratic vision	Occasional/Mild Frequent/Moderate Severe/Disabling
Burning or tearing of eyes	Occasional/Mild Frequent/Moderate Severe/Disabling
Recurrent infections or fluid in ears	Occasional/Mild Frequent/Moderate Severe/Disabling
Ear pain or deafness	Occasional/Mild Frequent/Moderate Severe/Disabling

Candida Free

Finally, a lasting solution

Yeast Questionnaire

Section A: History

Section B: Major Symptoms

Section C: Other Symptoms

Section D: Gender