Wellness.wholistic.com

andida Questionnaire and Score Sheet
This questionnaire is designed for adults and the scoring system is not appropriate for
children. 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).
Circle your answer for each question. At the end of Section A, give yourself one point
for each “Yes” answer and record your total score on the line 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 physician evaluate
the possible role of Candida in contributing to your health problems. Yet it will not pro-
vide an automatic “Yes” or “No” answer.
SECTION A: HISTORY
1. Have you taken tetracyclines (Sumycin, Panmycin, Vibramycin,
Minocin, etc.) or other antibiotics for acne for 1 month (or longer)?
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)?
3. Have you taken a broad spectrum antibiotic drug, even a single course?
4. Have you, at any time in your life, been bothered by persistent
prostatitis, vaginitis, or other problems affecting your reproductive organs? Yes / No
5. Have you been pregnant 2 or more times?
6. Have you taken birth control pills?
For more than 2 years?
For more than 6 months to 2 years?
7. Have you taken Prednisone, Decadron, or other cortisone-type drugs?
For more than 2 weeks?
For 2 weeks or less?
CANDIDA QUESTIONNAIRE
8. Does exposure to perfumes, insecticides, fabric shop odors, and other
chemicals provoke.
Moderate to severe symptoms?
Mild symptoms?
9. Are your symptoms worse on damp, muggy days, or in moldy places?
10. Have you had athlete’s foot, ring worm, “jock itch,” or other chronic
fungal infections of the skin or nails?
Have such infections been.
Severe or persistent?
Mild to moderate?
11. Do you crave sugar?
12. Do you crave breads?
13. Do you crave alcoholic beverages?
14. Does tobacco smoke really bother you?
Total Score, Section A .
SECTION B: MAJOR SYMPTOMS
Circle your answer for each question. 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. Add your total score and record
it in the box at the end of the section.
1. Fatigue or lethargy
Mild (3) / Moderate (6) / Severe (9)
2. Feeling of being “drained”
Mild (3) / Moderate (6) / Severe (9)
3. Depression
Mild (3) / Moderate (6) / Severe (9)
4. Poor memory
Mild (3) / Moderate (6) / Severe (9)
5. Feeling “spacey” or “unreal”
Mild (3) / Moderate (6) / Severe (9)
6. Inability to make decisions
Mild (3) / Moderate (6) / Severe (9)
7. Numbness, burning, or tingling
Mild (3) / Moderate (6) / Severe (9)
8. Headache
Mild (3) / Moderate (6) / Severe (9)
9. Muscle aches
Mild (3) / Moderate (6) / Severe (9)
CANDIDA QUESTIONNAIRE
10. Muscle weakness or paralysis
Mild (3) / Moderate (6) / Severe (9)
11. Pain and / or swelling in joints
Mild (3) / Moderate (6) / Severe (9)
12. Abdominal pain
Mild (3) / Moderate (6) / Severe (9)
13. Constipation and / or diarrhea
Mild (3) / Moderate (6) / Severe (9)
14. Bloating, belching, or intestinal gas
Mild (3) / Moderate (6) / Severe (9)
15. Vaginal burning, itching, or discharge
Mild (3) / Moderate (6) / Severe (9)
16. Prostatitis
Mild (3) / Moderate (6) / Severe (9)
17. Impotence
Mild (3) / Moderate (6) / Severe (9)
18. Loss of sexual desire or feeling
Mild (3) / Moderate (6) / Severe (9)
19. Endometriosis or infertility
Mild (3) / Moderate (6) / Severe (9)
20. Cramps and / or other menstrual irregularities
Mild (3) / Moderate (6) / Severe (9)
21. Premenstrual tension
Mild (3) / Moderate (6) / Severe (9)
22. Attacks of anxiety or crying
Mild (3) / Moderate (6) / Severe (9)
23. Cold hands or feet and / or chilliness
Mild (3) / Moderate (6) / Severe (9)
24. Shaking or irritable when hungry
Mild (3) / Moderate (6) / Severe (9)
Total Score, Section B .
SECTION C: OTHER SYMPTOMS
Circle your answer for each question. If a symptom is occasional / mild, score 1 point.
If a symptom is frequent and / or moderately severe, score 2 points. If a symptom is
severe and / or disabling, score 3 points. Add your total score and record it in the box
at the end of the section.
1. Drowsiness
Mild (1 ) / Moderate (2) / Severe (3)
2. Irritability or jitteriness
Mild (1 ) / Moderate (2) / Severe (3)
3. Incoordination
Mild (1 ) / Moderate (2) / Severe (3)
4. Inability to concentrate
Mild (1 ) / Moderate (2) / Severe (3)
5. Frequent mood swings
Mild (1 ) / Moderate (2) / Severe (3)
6. Insomnia
Mild (1 ) / Moderate (2) / Severe (3)
7. Dizziness / loss of balance
Mild (1 ) / Moderate (2) / Severe (3)
8. Pressure above ears, feeling of head swelling
Mild (1 ) / Moderate (2) / Severe (3)
CANDIDA QUESTIONNAIRE
9. Tendency to bruise easily
Mild (1 ) / Moderate (2) / Severe (3)
10. Chronic rashes or itching
Mild (1 ) / Moderate (2) / Severe (3)
11. Numbness, tingling
Mild (1 ) / Moderate (2) / Severe (3)
12. Indigestion or heartburn
Mild (1 ) / Moderate (2) / Severe (3)
13. Food sensitivity or intolerance
Mild (1 ) / Moderate (2) / Severe (3)
14. Mucus in stools
Mild (1 ) / Moderate (2) / Severe (3)
15. Rectal itching
Mild (1 ) / Moderate (2) / Severe (3)
16. Dry mouth or throat
Mild (1 ) / Moderate (2) / Severe (3)
17. Rash or blisters in mouth
Mild (1 ) / Moderate (2) / Severe (3)
18. Bad breath
Mild (1 ) / Moderate (2) / Severe (3)
19. Food, hair, or body odor not relieved by washing Mild (1 ) / Moderate (2) / Severe (3)
20. Nasal congestion or postnasal drip
Mild (1 ) / Moderate (2) / Severe (3)
21. Nasal itching
Mild (1 ) / Moderate (2) / Severe (3)
22. Sore throat
Mild (1 ) / Moderate (2) / Severe (3)
23. Laryngitis, loss of voice
Mild (1 ) / Moderate (2) / Severe (3)
24. Cough or recurrent bronchitis
Mild (1 ) / Moderate (2) / Severe (3)
25. Pain or tightness in chest
Mild (1 ) / Moderate (2) / Severe (3)
26. Wheezing or shortness of breath
Mild (1 ) / Moderate (2) / Severe (3)
27. Urinary frequency or urgency
Mild (1 ) / Moderate (2) / Severe (3)
28. Burning on urination
Mild (1 ) / Moderate (2) / Severe (3)
29. Spots in front of eyes or erratic vision
Mild (1 ) / Moderate (2) / Severe (3)
30. Burning or tearing of eyes
Mild (1 ) / Moderate (2) / Severe (3)
31. Recurrent infections or fluid in ears
Mild (1 ) / Moderate (2) / Severe (3)
32. Ear pain or deafness
Mild (1 ) / Moderate (2) / Severe (3)
Total Score, Section C .
CANDIDA QUESTIONNAIRE
GRAND TOTAl SCORE
Re-enter all your scores from the previous sections below and add them up to get your
grand total 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 physician 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.
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.
Yeast-connected health problems are less apt to cause health problems in women with
scores of less than 60 and in men with scores of less than 40.

Source: http://www.wellness.wholistic.com/forms/wholistic_candida.pdf