CANDIDA QUESTIONNAIRE AND SCORE SHEET

    This questionnaire is designed for adults and the scoring system isn't 
    appropriate for children. It lists factors in your medical history which 
    promote the growth of the common yeast, Candida Albicans (Section A), and 
    symptoms commonly found in individuals with yeast-connected illness 
    (Sections B and C).
    
    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 and score as directed.
    Filling out and scoring this questionnaire should help you and your physician 
    evaluate the possible role of yeasts in contributing to your health problems. 
        Yet it will not provide an automatic "Yes" or "No" answer.

                                   SECTION A: HISTORY

                                                                                      Point
                                                                                      Score
1.Have you taken tetracyclines (Sumycin®, Panmycin®, Vibramycin®, Minocen®, etc.) or
  other antibiotics for acne for I month (or longer)?..................................35

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)?.........................................35

3.Have you taken a broad spectrum antibiotic drug*---even a single course?..............6


4.Have you, at any time in your life, been bothered by persistent prostatitis, 
vaginitis or other problems affecting your reproductive organs?........................25

5.Have you been pregnant...
  2 or more times?......................................................................5
  1 time?...............................................................................3

6.Have you taken birth control pills...
  For more than 2 years?...............................................................15
  For 6 months to 2 years?..............................................................8

7.Have you taken prednisone, Decadron® or other cortisone-type drugs...
  For more than 2 weeks?...............................................................15
  For 2 weeks or less?..................................................................6

8.Does exposure to perfumes, insecticides, fabric shop odors or other chemicals
  provoke...
  Moderate to severe symptoms?.........................................................20
  Mild symptoms?........................................................................5

9.Are your symptoms worse on damp, muggy days or in moldy places?......................20

10.Have you had athlete's foot, ring worm, "jock itch" or other chronic fungous 
   infections of the skin or nails? Have such infections been...
   Severe or persistent?...............................................................20
   Mild to moderate?...................................................................10

11.Do you crave sugar?.................................................................10

12.Do you crave breads?................................................................10

13.Do you crave alcoholic beverages?...................................................10

14.Does tobacco smoke really bother you?...............................................10
   
Total Score, Section A .............................................................__________

       *including Keflex®, ampicillin, amoxicillin, Ceclor®, Bactrirn®, and Septra®. 
        Such antibiotics kill off the "good germs" while they're killing off those 
        which cause infection.