YEAST RELATED ILLNESS Questionnaires Food Intolerance Bible Buy Supplements

Have I Got A Yeast Overgrowth?

For each 'Yes' answer in Section A, circle the Point Score in that section. Total your score and record it at the end of the section. Then move on to Sections B and C and score as directed.

Section A: History

1.	Have you taken tetracycline (or other antibiotics) for 2 months (or longer)?	25
2.	Have you, at any time in your life, taken other 'broad-spectrum'antibiotics (including Keflex®, ampicillin, amoxicillin, Ceclor®, Bactrim®, and Septra®*) for respiratory, urinary or other infections for two months or longer, or in shorter courses four or more times in a one-year period?	20
3.	Have you, at any time in your life, been troubled by persistent vaginal problems or had three or more episodes of vaginitis in a year?	25
4.	Have you been pregnant more than twice?	5
	Have you been pregnant once?	3
5.	Have you taken birth control pills for more than two year?	15
	For six months to two years?	18
6.	Have you taken prednisone, Decadron® or other cortisone-type drugs for more than two weeks?	15
	For less than two weeks?	6
7.	Does exposure to perfumes, insecticides, fabric shop odours and other chemicals provoke...
	Moderate to severe symptoms?	20
	Mild symptoms?	5
8.	Are your symptoms worse on damp, muggy days or in mouldy places?	20
9.	Have you had persistent athlete's foot, 'jock itch' or other chronic fungal infections of the skin or nails? Have such infections been ...
	Severe or persistent?	20
	Mild to moderate?	10
10.	Do you crave sugar?	10
11.	Do you crave breads?	10
12.	Do you crave alcohol	10
13.	Does tobacco smoke really bother you?	10

Section B: Major Symptoms

For each symptom which is present, enter the appropriate figure in the Point Score column:

If a symptom is mild, score 3 points
If a symptom is moderate, score 6 points
If a symptom is severe or disabling, score 9 points

Fatigue or lethargy.
Feeling of being 'drained'
Poor memory
Feeling 'spacey' or 'unreal'
Depression
Numbness, burning or tingling
Muscle aches
Muscle weakness or paralysis
Pain and/or swelling in joints
Abdominal pain
Constipation
Diarrhoea
Bloating
Troublesome vaginal discharge
Persistent vaginal burning or itching
Prostatitis (inflamed, enlarged prostate)
Impotence
Loss of sexual feeling
Endometriosis
Dysmenorrhea (painful periods)
Premenstrual tension
Spots in front of eyes
Erratic Vision

Total Score Section B =

Section C: Other Symptoms

For each symptom which is present, enter the appropriate figure in the Point Score column:

If a symptom is mild, score 1 point
If a symptom is moderate, score 2 points
If a symptom is severe or disabling, score 3 points

While the symptoms in this section occur commonly in patients with yeast-connected illness, they also occur commonly in patients who do not have an overgrowth of Candida.

Drowsiness
Irritability or jitteriness
Incoordination
Inability to concentrate
Frequent mood swings
Headache
Dizziness/loss of balance
Pressure above ears...feeling of head swelling and tingling
Itching
Other rashes
Heartburn
Indigestion
Belching and intestinal gas
Mucus in stools
Hemorrhoids
Dry mouth
Rash or blisters in mouth
Bad breath
Joint swelling or arthritis
Nasal congestion or discharge
Postnasal drip
Nasal itching
Sore or dry throat
Cough
Pain or tightness in chest
Wheezing or shortness of breath
Urgency or urinary frequency
Burning on urination
Failing vision
Burning or tearing eyes
Recurrent ear infections
Fluid in ears
Ear pain or deafness
Tubes in ears
Other symptoms:

Total Score Section C =

Section A ............
Section B ............
Section C ............
Total ............

Yeast Related Illness