History                                                         Point Score

  1. Have you taken tetracycline 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 two months or longer, or in short courses four or more times in a one-year period? 20
  3. Have you ever taken a broad-spectrum antibiotic (even a single course)? 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 you been pregnant one time? 3  Two or more times? 5
  6. Have you ever taken birth control pills for six months to two years? 8  For more than two years? 15
  7. Have you taken prednisone or other cortisone type drugs for two weeks or less? 6  For more than two weeks? 15
  8. Does exposure to perfumes, insecticides, fabric shop odors, and other chemicals provoke mild symptoms? 5   Provoke moderate to severe symptoms? 20
  9. Are your symptoms worse on damp, muggy days or moldy places? 20
  10. Have you had athlete’s foot, ringworm, “jock itch,” or other chronic infections of the skin or nails? Mild to moderate? 10  Severe or persistent? 20
  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

ADD UP YOUR TOTAL SCORE FOR THIS SECTION                                                           __________

 

Major Symptoms                                                                                                                    Point Score

For each of your symptoms below, enter the appropriate figure in the Point Score Column.

If symptom is occasional or mild                                                                                             score 3 points

If symptom is frequent and/or moderately severe                                                                  score 6 points

If a symptom is severe and/or disabling                                                                                 score 9 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. Persistent vaginal itch
  15. Persistent vaginal burning
  16. Prostatitis
  17. Impotence
  18. Loss of sexual desire
  19. Endometriosis
  20. Cramping and other menstrual irregularities
  21. Premenstrual tension
  22. Spots in front of eyes
  23. Erratic vision

TOTAL SCORE FOR THIS SECTION                                                                                                __________

Other Symptoms

For each of the symptoms below, enter the appropriate figure in the point Score Column.

If symptom is occasional or mild                                                                                                          score 1 point

If symptom is frequent and/or moderately severe                                                                               score 2 points

If a symptom is severe and/or disabling                                                                                              score 3 points

  1. Drowsiness
  2. Irritability
  3. Lack of coordination
  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 blisters 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 on urination
  29. Failing vision
  30. Burning or tearing of eyes
  31. Recurrent infections or fluid in ears
  32. Ear pain or deafness

TOTAL SCORE FOR THIS SECTION                                                                                        ______________

NOW ADD UP YOUR SCORES

Total Score from section one                                                                                                        ______________

Total score from section two                                                                                                         ______________

Total score for section three                                                                                                         ______________

TOTAL ALL SECTIONS                                                                                                              ______________

 

                                          Women             Men

Yeast- connected health problems are almost certainly present                                                   >180           >140

Yeast-connected health problems are probably present                                                              120-180     90-140

Yeast-connected health problems are possibly present                                                                60-119        40-89

Yeast-connected health problems are less likely to be present                                                      <60             <40

This questionnaire is adapted from W. G. Crook The Yeast Connection.

 

Although the Candida Questionnaire can help determine your condition, ultimately the best method for diagnosing candidiasis is clinical evaluation by a physician knowledgeable about yeast-related illness.

If your score indicates you have a yeast overgrowth, I highly recommend the yeast control products:  Yeast Max, YeastZyme Max, and Ultimate FloraMax Advanced Care 100 Billion