Microsoft word - candidaquestionaire

Section A: History
Instructions: For each yes answer in section A, Circle the Point Score in that section. Total your
score and record it in the box at the end of the section. Then move on to Sections B and C,
scoring as directed.
Have you taken tetracylines (Sumycin, Panmycin, Vibramycin, Minocin, etc.) or other antibiotic for acne for 1 month or longer? Have you ever taken other "broad spectrum" antibiotics for urinary, respiratory or other infections for 2 months or longer, or in shorter courses 4 or more timesin a 1 year period? Have you ever taken a "broad spectrum" antibiotic drug – even for one period? Have you ever been bothered by persistent prostatitis, vaginitis, or other problems that affect your reproductive organs? Have you ever been pregnant – 2 or more times? Have you taken birth control pills for - more than 2 years? Have you taken prednisone, Decadron or other cortisone type drugs for… - Does exposure to perfumes, insecticides, fabric shop odors or other chemicals provoke… - Moderate to severe symptoms? Are symptoms worse on damp, muggy days or in moldy places? Have you had athlete’s foot, ring worm, "jock itch" or other chronic fungous Do you crave breads or other foods high in carbohydrates? Total Score – Section A
Section B: Major Symptoms
Instructions: For each symptom that is present, enter the appropriate number in the Point Score
Column.
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.
Total the score for this section and record it in the box at the end of this section.
Feeling "spacey" or "unreal" Troublesome vaginal burning, itching or discharge Cramps and/or other menstrual irregularities Total Score – Section B
Section C: Other Symptoms
Instructions: For each symptom that is present, enter the appropriate number in the Point Score
Column.
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 persistent……………….score 9 points.
Total the score for this section and record it in the box at the end of this section.
Pressure above ears, feeling of head swelling/tingling Foot, hair or body odor not relieved by washing Nasal congestion, discharge or post nasal drip Urgency frequency, urgency or incontinence Test Scoring & Results
Total Score – Section A
Total Score – Section B
Total Score – Section C
Grand Total Score (add sections A, B & C)
The Grand Total Score will help you and your health care provider decide if your health
problems are yeast-connected. Scores for woman will typically run higher.
Yeast-connected health problems are almost certainly present in woman with scores over 180,
and in men with scores over 140.
Yeast-connected health problems are probably present in woman with scores over 120 and in
men with scores over 90.
Yeast-connected health problems are possibly present in woman with scores over 60 and in men
with scores over 40.
With scores less than 60 for woman and 40 for men, yeast are less apt to cause health problems.

Source: http://www.anewleafnaturopathic.com/uploads/documents/candidaquestionaire.pdf