SECTION C: OTHER SYMPTOMS* For each symptom which is present, enter the appropriate figure in the Point Score column: If a symptom is occasional or mild ..........................score 1 point. If a symptom is frequent and/or moderately severe ...........score 2 points. Ifa symptom is severe and/or persistent .....................score 3 points. Add total score for this section and record it in the box at the end of this section. Point Score 1. Drowsiness......................................................._______________ 2. Irritability orjitteriness......................................._______________ 3. Incoordination..................................................._______________ 4. Inability to concentrate........................................._______________ 5. Frequent mood swings............................................._______________ 6. Headache........................................................._______________ 7. Dizziness/loss of balance........................................._______________ 8. Pressure above ears...feeling of head swelling...................._______________ 9. Tendency to bruise easily........................................._______________ 10. Chronic rashes or itching........................................_______________ 11. Psoriasis or recurrent hives....................................._______________ 12. Indigestion or heartburn........................................._______________ 13. Food sensitivity or intolerance.................................._______________ 14. Mucus in stools.................................................._______________ 15. Rectal itching..................................................._______________ 16. Dry mouth or throat.............................................._______________ 17. Rash or blisters in mouth........................................_______________ 18. Bad breath......................................................._______________ 19. Foot, hair or body odor not relieved by washing.................._______________ 20. Nasal congestion or post nasal drip.............................._______________ 21. Nasal itching...................................................._______________ 22. Sore throat......................................................_______________ 23. Laryngitis, loss of voice........................................_______________ 24. Cough or recurrent bronchitis...................................._______________ 25. Pain or tightness in chest......................................._______________ 26. Wheezing or shortness of breath.................................._______________ 27. Urinary frequency, urgency, or incontinence......................_______________ 28. Burning on urination............................................._______________ 29. Spots in front of eyes or erratic vision........................._______________ 30. Burning or tearing of eyes......................................._______________ 31. Recurrant infections or fluid in ears............................_______________ 32. Ear pain or deafness............................................._______________ Total Score, Section C .............................................._______________ Total Score, Section B .............................................._______________ Total Score, Section A .............................................._______________ GRAND TOTAL SCORE (Add up Total Score from Sections A, B, and C) ...._______________ The Grand Total Score will help you and your physician decide if your health problems are yeastconnected. Scores in women will run higher as 7 items in the questionnaire apply exclusively to women, while only 2 apply exclusively to men. CANDIDA QUESTIONAIRE SCORING If the total score is 75 and 150 you are considered to have a MODERATE CONDITION. If your total score is 151 to 225 you are considered to have a SERIOUS condition. If your total score is 225 to 275 you are considersd to have a SEVERE condition. If your score is over 275 you may possibly have an EXTREME condition. The Candida Questionnaire is reprinted from "The Yeast Connection Handbook" by William Crook, M.D., and is used with permission. *While the symptoms in this section occur commonly in patients with yeast-connected illness, they also occur commonly in patients who do not have candida.