Candida Questionnaire• Take your time and answer all questions to the best

of your knowledge. • Upon completion you will be provided with a score. • Your score will help you determine to what degree

yeast may be connected to your health concerns.• Do not consider the results as a diagnosis.

As always, consult your physician.• Be honest with yourself. Don’t cheat your health!

MALE FEMALE

Choose your gender:

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Have you taken tetracycline or other antibiotics for acne for [1] month (or longer)?

yes no

Have you ever taken broad-spectrum antibiotics or other antibacterial medication for [2] months or longer? Or, in shorter courses, [4] or more times in a one-year period?(typically for respiratory, urinary or other infections)

yes no

Have you taken a broad-spectrum antibiotic drug—even in a single dose?

yes no

Have you, at any time in your life, been bothered by persistent prostatitis, vaginitis or other problems affecting your reproductive organs?

yes no

Are you bothered by memory or concentration problems—do you sometimes feel spaced out?

yes no

Do you feel ‘‘sick all over’’ yet, in spite of visits to many different physicians, the causes haven’t been found?

yes no

Have you been pregnant?

once twice or moreno

Have you taken birth control pills?

6 months - 2 years

more than 2 years

no

Have you taken steroids - orally, by injection, or inhalation?

less than 2 weeks

more than 2 weeks

no

Does tobacco smoke really bother you?

yes no

Does exposure to perfumes, insecticides, fabric shop odors and other chemicals provoke . . .mild reaction

moderate to severe

nothing

Are your symptoms worse on damp, muggy days or in moldy places?

yes no

Have you had athlete’s foot, ring worm, ‘‘jock itch’’ or other chronic fungous infections of the skin or nails? mild to moderate

severe or persistent

no

Fatigue or lethargy

How often, or to what degree, do you experience the following

symptoms:

none/ negligible

occaisonal/ mild

frequent/ moderate

severe/ disabling

Feeling of being “drained”

none/ negligible

occaisonal/ mild

frequent/ moderate

severe/ disabling

Depression or manic depression

none/ negligible

occaisonal/ mild

frequent/ moderate

severe/ disabling

Numbness, burning or tingling

none/ negligible

occaisonal/ mild

frequent/ moderate

severe/ disabling

Headaches

none/ negligible

occaisonal/ mild

frequent/ moderate

severe/ disabling

Muscle aches

none/ negligible

occaisonal/ mild

frequent/ moderate

severe/ disabling

Muscle weakness or paralysis

none/ negligible

occaisonal/ mild

frequent/ moderate

severe/ disabling

Pain and/or swelling in joints

none/ negligible

occaisonal/ mild

frequent/ moderate

severe/ disabling

Abdominal pain

none/ negligible

occaisonal/ mild

frequent/ moderate

severe/ disabling

Constipation and/or diarrhea

none/ negligible

occaisonal/ mild

frequent/ moderate

severe/ disabling

Bloating, belching or intestinal gas

none/ negligible

occaisonal/ mild

frequent/ moderate

severe/ disabling

Troublesome vaginal burning, itching or discharge

none/ negligible

occaisonal/ mild

frequent/ moderate

severe/ disabling

Prostatitis

none/ negligible

occaisonal/ mild

frequent/ moderate

severe/ disabling

Impotence

none/ negligible

occaisonal/ mild

frequent/ moderate

severe/ disabling

Loss of sexual desire or feeling

none/ negligible

occaisonal/ mild

frequent/ moderate

severe/ disabling

Endometriosis or infertility

none/ negligible

occaisonal/ mild

frequent/ moderate

severe/ disabling

Cramps and/or other menstrual irregularities

none/ negligible

occaisonal/ mild

frequent/ moderate

severe/ disabling

Premenstrual tension

none/ negligible

occaisonal/ mild

frequent/ moderate

severe/ disabling

Attacks of anxiety or crying

none/ negligible

occaisonal/ mild

frequent/ moderate

severe/ disabling

Cold hands or feet, low body temperature

none/ negligible

occaisonal/ mild

frequent/ moderate

severe/ disabling

Hypothyroidism

none/ negligible

occaisonal/ mild

frequent/ moderate

severe/ disabling

Shaking or irritable when hungry

none/ negligible

occaisonal/ mild

frequent/ moderate

severe/ disabling

Cystitis or interstitial cystitis

none/ negligible

occaisonal/ mild

frequent/ moderate

severe/ disabling

Drowsiness, including inappropriate drowsiness

none/ negligible

occaisonal/ mild

frequent/ moderate

severe/ disabling

Irritability

none/ negligible

occaisonal/ mild

frequent/ moderate

severe/ disabling

Incoordination

none/ negligible

occaisonal/ mild

frequent/ moderate

severe/ disabling

Frequent mood swings

none/ negligible

occaisonal/ mild

frequent/ moderate

severe/ disabling

Insomnia

none/ negligible

occaisonal/ mild

frequent/ moderate

severe/ disabling

Dizziness/loss of balance

none/ negligible

occaisonal/ mild

frequent/ moderate

severe/ disabling

Pressure above ears…feeling of head swelling

none/ negligible

occaisonal/ mild

frequent/ moderate

severe/ disabling

Sinus problems…tenderness of cheekbones or forehead

none/ negligible

occaisonal/ mild

frequent/ moderate

severe/ disabling

Tendency to bruise easily

none/ negligible

occaisonal/ mild

frequent/ moderate

severe/ disabling

Eczema, itching eyes

none/ negligible

occaisonal/ mild

frequent/ moderate

severe/ disabling

Psoriasis

none/ negligible

occaisonal/ mild

frequent/ moderate

severe/ disabling

Chronic hives (urticaria)

none/ negligible

occaisonal/ mild

frequent/ moderate

severe/ disabling

Indigestion or heartburn

none/ negligible

occaisonal/ mild

frequent/ moderate

severe/ disabling

Sensitivity to milk, wheat, cornor other common foods

none/ negligible

occaisonal/ mild

frequent/ moderate

severe/ disabling

Mucus in stools

none/ negligible

occaisonal/ mild

frequent/ moderate

severe/ disabling

Rectal itching

none/ negligible

occaisonal/ mild

frequent/ moderate

severe/ disabling

Dry mouth or throat

none/ negligible

occaisonal/ mild

frequent/ moderate

severe/ disabling

Mouth rashes, including “white” tongue

none/ negligible

occaisonal/ mild

frequent/ moderate

severe/ disabling

Bad breath

none/ negligible

occaisonal/ mild

frequent/ moderate

severe/ disabling

Foot, hair or body odornot relieved by washing

none/ negligible

occaisonal/ mild

frequent/ moderate

severe/ disabling

Nasal congestionor postnasal drip

none/ negligible

occaisonal/ mild

frequent/ moderate

severe/ disabling

Nasal itching

none/ negligible

occaisonal/ mild

frequent/ moderate

severe/ disabling

Sore throat

none/ negligible

occaisonal/ mild

frequent/ moderate

severe/ disabling

Laryngitis, loss of voice

none/ negligible

occaisonal/ mild

frequent/ moderate

severe/ disabling

Couch or recurrent bronchitis

none/ negligible

occaisonal/ mild

frequent/ moderate

severe/ disabling

Pain or tightness in chest

none/ negligible

occaisonal/ mild

frequent/ moderate

severe/ disabling

Wheezing or shortness of breath

none/ negligible

occaisonal/ mild

frequent/ moderate

severe/ disabling

Urinary frequency or urgency

none/ negligible

occaisonal/ mild

frequent/ moderate

severe/ disabling

Burning or urination

none/ negligible

occaisonal/ mild

frequent/ moderate

severe/ disabling

Spots in front of eyes

none/ negligible

occaisonal/ mild

frequent/ moderate

severe/ disabling

Burning or tearing eyes

none/ negligible

occaisonal/ mild

frequent/ moderate

severe/ disabling

Recurrent infections or fluid in ears

none/ negligible

occaisonal/ mild

frequent/ moderate

severe/ disabling

Ear pain or deafness

none/ negligible

occaisonal/ mild

frequent/ moderate

severe/ disabling

Calculating your results…

Your score is104