Candida Questionnaire Take your time and answer all questions to the best of your knowledge. Upon...
-
Upload
kacie-beckham -
Category
Documents
-
view
212 -
download
0
Transcript of Candida Questionnaire Take your time and answer all questions to the best of your knowledge. Upon...
Candida Questionnaire• Take your time and answer all questions to the best
of your knowledge. • Upon completion you will be provided with a score. • Your score will help you determine to what degree
yeast may be connected to your health concerns.• Do not consider the results as a diagnosis.
As always, consult your physician.• Be honest with yourself. Don’t cheat your health!
MALE FEMALE
Choose your gender:
CLICK HERE TO BEGIN!
Have you taken tetracycline or other antibiotics for acne for [1] month (or longer)?
yes no
Have you ever taken broad-spectrum antibiotics or other antibacterial medication for [2] months or longer? Or, in shorter courses, [4] or more times in a one-year period?(typically for respiratory, urinary or other infections)
yes no
Have you taken a broad-spectrum antibiotic drug—even in a single dose?
yes no
Have you, at any time in your life, been bothered by persistent prostatitis, vaginitis or other problems affecting your reproductive organs?
yes no
Are you bothered by memory or concentration problems—do you sometimes feel spaced out?
yes no
Do you feel ‘‘sick all over’’ yet, in spite of visits to many different physicians, the causes haven’t been found?
yes no
Have you been pregnant?
once twice or moreno
Have you taken birth control pills?
6 months - 2 years
more than 2 years
no
Have you taken steroids - orally, by injection, or inhalation?
less than 2 weeks
more than 2 weeks
no
Does tobacco smoke really bother you?
yes no
Does exposure to perfumes, insecticides, fabric shop odors and other chemicals provoke . . .mild reaction
moderate to severe
nothing
Are your symptoms worse on damp, muggy days or in moldy places?
yes no
Have you had athlete’s foot, ring worm, ‘‘jock itch’’ or other chronic fungous infections of the skin or nails? mild to moderate
severe or persistent
no
Fatigue or lethargy
How often, or to what degree, do you experience the following
symptoms:
none/ negligible
occaisonal/ mild
frequent/ moderate
severe/ disabling
Feeling of being “drained”
none/ negligible
occaisonal/ mild
frequent/ moderate
severe/ disabling
Depression or manic depression
none/ negligible
occaisonal/ mild
frequent/ moderate
severe/ disabling
Numbness, burning or tingling
none/ negligible
occaisonal/ mild
frequent/ moderate
severe/ disabling
Headaches
none/ negligible
occaisonal/ mild
frequent/ moderate
severe/ disabling
Muscle aches
none/ negligible
occaisonal/ mild
frequent/ moderate
severe/ disabling
Muscle weakness or paralysis
none/ negligible
occaisonal/ mild
frequent/ moderate
severe/ disabling
Pain and/or swelling in joints
none/ negligible
occaisonal/ mild
frequent/ moderate
severe/ disabling
Abdominal pain
none/ negligible
occaisonal/ mild
frequent/ moderate
severe/ disabling
Constipation and/or diarrhea
none/ negligible
occaisonal/ mild
frequent/ moderate
severe/ disabling
Bloating, belching or intestinal gas
none/ negligible
occaisonal/ mild
frequent/ moderate
severe/ disabling
Troublesome vaginal burning, itching or discharge
none/ negligible
occaisonal/ mild
frequent/ moderate
severe/ disabling
Prostatitis
none/ negligible
occaisonal/ mild
frequent/ moderate
severe/ disabling
Impotence
none/ negligible
occaisonal/ mild
frequent/ moderate
severe/ disabling
Loss of sexual desire or feeling
none/ negligible
occaisonal/ mild
frequent/ moderate
severe/ disabling
Endometriosis or infertility
none/ negligible
occaisonal/ mild
frequent/ moderate
severe/ disabling
Cramps and/or other menstrual irregularities
none/ negligible
occaisonal/ mild
frequent/ moderate
severe/ disabling
Premenstrual tension
none/ negligible
occaisonal/ mild
frequent/ moderate
severe/ disabling
Attacks of anxiety or crying
none/ negligible
occaisonal/ mild
frequent/ moderate
severe/ disabling
Cold hands or feet, low body temperature
none/ negligible
occaisonal/ mild
frequent/ moderate
severe/ disabling
Hypothyroidism
none/ negligible
occaisonal/ mild
frequent/ moderate
severe/ disabling
Shaking or irritable when hungry
none/ negligible
occaisonal/ mild
frequent/ moderate
severe/ disabling
Cystitis or interstitial cystitis
none/ negligible
occaisonal/ mild
frequent/ moderate
severe/ disabling
Drowsiness, including inappropriate drowsiness
none/ negligible
occaisonal/ mild
frequent/ moderate
severe/ disabling
Irritability
none/ negligible
occaisonal/ mild
frequent/ moderate
severe/ disabling
Incoordination
none/ negligible
occaisonal/ mild
frequent/ moderate
severe/ disabling
Frequent mood swings
none/ negligible
occaisonal/ mild
frequent/ moderate
severe/ disabling
Insomnia
none/ negligible
occaisonal/ mild
frequent/ moderate
severe/ disabling
Dizziness/loss of balance
none/ negligible
occaisonal/ mild
frequent/ moderate
severe/ disabling
Pressure above ears…feeling of head swelling
none/ negligible
occaisonal/ mild
frequent/ moderate
severe/ disabling
Sinus problems…tenderness of cheekbones or forehead
none/ negligible
occaisonal/ mild
frequent/ moderate
severe/ disabling
Tendency to bruise easily
none/ negligible
occaisonal/ mild
frequent/ moderate
severe/ disabling
Eczema, itching eyes
none/ negligible
occaisonal/ mild
frequent/ moderate
severe/ disabling
Psoriasis
none/ negligible
occaisonal/ mild
frequent/ moderate
severe/ disabling
Chronic hives (urticaria)
none/ negligible
occaisonal/ mild
frequent/ moderate
severe/ disabling
Indigestion or heartburn
none/ negligible
occaisonal/ mild
frequent/ moderate
severe/ disabling
Sensitivity to milk, wheat, cornor other common foods
none/ negligible
occaisonal/ mild
frequent/ moderate
severe/ disabling
Mucus in stools
none/ negligible
occaisonal/ mild
frequent/ moderate
severe/ disabling
Rectal itching
none/ negligible
occaisonal/ mild
frequent/ moderate
severe/ disabling
Dry mouth or throat
none/ negligible
occaisonal/ mild
frequent/ moderate
severe/ disabling
Mouth rashes, including “white” tongue
none/ negligible
occaisonal/ mild
frequent/ moderate
severe/ disabling
Bad breath
none/ negligible
occaisonal/ mild
frequent/ moderate
severe/ disabling
Foot, hair or body odornot relieved by washing
none/ negligible
occaisonal/ mild
frequent/ moderate
severe/ disabling
Nasal congestionor postnasal drip
none/ negligible
occaisonal/ mild
frequent/ moderate
severe/ disabling
Nasal itching
none/ negligible
occaisonal/ mild
frequent/ moderate
severe/ disabling
Sore throat
none/ negligible
occaisonal/ mild
frequent/ moderate
severe/ disabling
Laryngitis, loss of voice
none/ negligible
occaisonal/ mild
frequent/ moderate
severe/ disabling
Couch or recurrent bronchitis
none/ negligible
occaisonal/ mild
frequent/ moderate
severe/ disabling
Pain or tightness in chest
none/ negligible
occaisonal/ mild
frequent/ moderate
severe/ disabling
Wheezing or shortness of breath
none/ negligible
occaisonal/ mild
frequent/ moderate
severe/ disabling
Urinary frequency or urgency
none/ negligible
occaisonal/ mild
frequent/ moderate
severe/ disabling
Burning or urination
none/ negligible
occaisonal/ mild
frequent/ moderate
severe/ disabling
Spots in front of eyes
none/ negligible
occaisonal/ mild
frequent/ moderate
severe/ disabling
Burning or tearing eyes
none/ negligible
occaisonal/ mild
frequent/ moderate
severe/ disabling
Recurrent infections or fluid in ears
none/ negligible
occaisonal/ mild
frequent/ moderate
severe/ disabling
Ear pain or deafness
none/ negligible
occaisonal/ mild
frequent/ moderate
severe/ disabling
Calculating your results…
Your score is104