CANDIDA QUESTIONNAIRE

Click here to print and fill out the questionnaire This candida questionnaire is designed for adults and the scoring system isn't appropriate for children 12 and under. 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 questionnaire 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.	scores
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" antibiotics* 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 antibiotic* -- even in a single course? * Including Keflex, ampicillin, amoxicillin, Ceclor, Bactrim, and Septra. Such antibiotics kill off "good germs" while they are killing off those which cause infection.	6
4. Have you, at anytime in your life, been bothered by persistent prostatitis, vaginitis, or other problems affecting your reproductive organs?	25
5. Have been pregnant 2 or more times? 1 time?	5 3
6. Have you taken birth control pills for more than 2 years? for 6 months to 2 years?	15 8
7. Have you taken Prednisone, Decadron or other cortisone-type drugs for more than 2 weeks? For 2 weeks or less?	15 6
8. Does exposure to perfumes, insecticides, fabric shop odors, and other chemicals provoke moderate to severe symptoms? Mild symptoms?	20 5
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? Have such infections been severe or persistent? Mild to moderate?	- 20 10
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
Point Score	____

Section B: Major Symptoms

For each of your symptoms, enter the appropriate figure in the point score column: 3 points - for occasional or Mild 6 points - for frequent and/or Moderately Severe 9 points - for severe and/or Disabling Add total score and record it in the box at the end of this section:	points
1. Fatigue or lethargy	______
2. Feeling of being "drained"	______
3. Poor memory	______
4. Feeling "spacey" or "unreal"	______
5. Depression	______
6. Numbness, burning, or tingling	______
7. Muscle aches	______
8. Muscle weakness or paralysis	______
9. Pain and/or swelling in joints	______
10. Abdominal pain	______
11. Constipation	______
12. Diarrhea	______
13. Bloating	______
14. Troublesome vaginal discharge	______
15. Persistent vaginal burning or itching	______
16. Prostatitis	______
17. Impotence	______
18. Loss of sexual desire	______
19. Endometriosis	______
20. Cramps and/or other menstrual irregularities	______
21. Premenstrual tension	______
22. Spots in front of the eyes	______
23. Erratic vision	______
Point Score	______

Section C: Other Symptoms

For each of your symptoms, enter the appropriate figure in the point score column: 1 point for occasional or Mild 2 points for frequent and/or Moderately Severe 3 points for severe and/or Disabling Add total score and record it in the box at the end of this section:	______
1. Drowsiness	______
2. Irritability or jitteriness	______
3. Incoordination	______
4. Inability to concentrate	______
5. Frequent mood swings	______
6. Headache	______
7. Dizziness/loss of balance	______
8. Pressure above ears, feeling of head swelling and tingling	______
9. Itching	______
10. Other rashes	______
11. Heartburn	______
12. Indigestion	______
13. Belching and intestinal gas	______
14. Mucus in stools	______
15. Hemorrhoids	______
16. Dry mouth	______
17. Rash or blister in mouth	______
18. Bad breath	______
19. Joint swelling or arthritis	______
20. Nasal congestion or discharge	______
21. Postnasal drip	______
22. Nasal itching	______
23. Sore or dry throat	______
24. Cough	______
25. Pain or tightness in chest	______
26. Wheezing or shortness of breath	______
27. Urinary urgency or frequency	______
28. Burning or tearing of eyes	______
29. Failing vision	______
30. Burning on urination	______
31. Recurrent infections or fluid in ears	______
32. Ear pain or deafness	______
Point Score	______

Total Score, Section A
Total Score, Section B
Total Score, Section C
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 questionnaire 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) 40 (men)	Probably Not Yeast Connected

Note:This test is not for diagnosing illness. If you have a serious health Problem consult with your health practitioner.



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Candida Questionnaire

CANDIDA QUESTIONNAIRE