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Candida Questionnaire and Score Sheet*
Section B: Major Symptoms
This questionnaire lists factors in your medical history that promote the growth of For each symptom that is present, enter the appropriate number in the Point Score the common yeast, Candida Albicans (Section A), and symptoms commonly
found in individuals with yeast-connected illness (Sections B and C). For each ves answer in Section A, circle the Point Score in that section. Total your score, and If a symptom is occasional or mild . score 3 points. record it in the box) at the end of the section. Then move on to Sections B and C, If a symptom is frequent and/or moderately severe . score 6 points. If a symptom is severe and/or disabling . score 9 points. Section A: History
Point Score
I . Have vou taken tetracyclines (Sumvcin, Panmycin~, Vibramycin, Total the score for this section, and record it in the box at the end of this section. Minocin, etc.) or other antibiotics for acne for 1 month (or longer)? Point Score
2. Have you, at any time in your life, taken other antibiotics for respiratory, urinary, or other infections, for 2 months or longer, or for shorter periods 4 3. Have you taken an antibiotic drug - even for one period? 4. Feeling "spacey" or "unreal" 4. Have you, at any time in your life, been bothered by persistent prostatitis, vaginitis, or other problems affecting your reproductive organs? 5. Have you been pregnant…. 2 or more times? 6. Have you taken birth control pills…. for more than 2 years? 7. Have you taken prednisone, Decadron, or other cortisone-type drugs by mouth or inhalation for… more than 2 weeks? 8. Does exposure to perfumes, insecticides, fabric shop odors, or other 14. Bloating, belching or intestinal gas chemicals provoke… moderate to severe symptoms? 15. Troublesome vaginal burning, itching or discharge 9. Are your symptoms worse on damp, muggy days or in moldy places? 10. Have you had athlete's foot, ringworm, "jock itch" or other chronic Have Such infections been… severe or persistent? 20. Cramps and/or other menstrual irregularities 23. Cold hands or feet and/or chilliness 14. Does tobacco smoke really bother you? Total Score, Section B
Total Score, Section
Section C: Other Symptoms*
Section C: Other Symptoms (continued)
For each symptom that is present, enter the appropriate number in the Point Score For each symptom that is present, enter the appropriate number in the Point Score If a symptom is occasional or mild . score 3 points. 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 frequent and/or moderately severe . score 6 points. If a symptom is severe and/or persistent . . score 9 points. If a symptom is severe and/or persistent . score 9 points. Total your score from previous
Total the score for this section, and record it in the box at the end of this section. Point Score
27. Urinary frequency, urgency, or incontinence 8. Pressure above ears . feeling of head swelling 29. Spots in front of eyes or erratic vision 3 1. Recurrent infections or fluid in ears GRAND TOTAL SCORE (add totals from Sections A, B, C)
The Grand Total Score will help you and your physician decide if your health problems are yeast-connected. Scores for women will run higher, as 7 items in this 19. Foot, hair or body odor not relieved by washing questionnaire apply exclusively to women, while only 2 apply exclusively to men.  Yeast-connected health problems are almost certainly present in women with *While the symptoms in this section occur commonly in patients with scores over 180, and in men with scores over 140.
yeast-connected illness, they also occur commonly in patients who do not have 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.
 With scores less than 60 for women and 40 for men, yeast are less apt to cause
This questionnaire is available in quantity from Professional Books, Inc., P.O. Box 3246, Jackson, TN 38302. Prices upon request. Copyright 1984. The Yeast Connection by William G. Crook, M.D. Reprinted with permission.

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