For each yes answer in Section A, circle the Point Score. 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 Point Score

1. Have you taken tetracyclines (Sumycin®, Panmycin®, Vibramycin®,Minocin®, etc.) or other antibiotics for acne for 1 month (or longer)? Point score-50

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 for shorter periods 4 or more times in a 1-year span? Point score-50

3. Have you taken a broad spectrum antibiotic drug – even for one period? Point score-6

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

5. Have you been pregnant 2 or more times?
Point score-5

Pregnant 1 time? Point score-3

6. Have you taken birth control pills for more than 2 years?
Point score-15

Taken birth control pills 6 months to 2 years?
Point score-8

7. Have you taken prednisone, Decadron®, or other cortisone-type drugs by mouth or inhalation** for more than 2 weeks?
Point score-15

Taken these drugs 2 weeks or less? Point score-6

8. Does exposure to perfumes, insecticides, fabric shop odors, or other chemicals provoke moderate to severe symptoms? Point score-20

Does exposure produce mild symptoms?
Point score-5

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

10.Have you had athlete’s foot, ringworm, "jock itch" or other chronic fungus infections of the skin or nails that have been severe or persistent? Point score-20

Mild or moderate? Point score-10

11. Do you crave sugar? Point score-10

12. Do you crave breads? Point score-10

13. Do you crave alcoholic beverages? Point score-10

14. Does tobacco smoke really bother you?
Point score-10

Total Score, Section A _______

**The use of nasal or bronchial sprays containing cortisone and/or other steroids promotes overgrowth in the respiratory tract.

Section B: Major Symptoms

For each symptom that is present, enter the appropriate number in the Point Score column:

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 severe and/or disabling, score 9 points.Total the score for this section, and record it at the end of this section.
Point Score

1. Fatigue or lethargy	_______
2. Feeling of being "drained"	_______
3. Poor memory	_______
4. Feeling "spacey" or "unreal"	_______
5. Inability to make decisions	_______
6. Numbness, burning or tingling	_______
7. Insomnia	_______
8. Muscle aches	_______
9. Muscle weakness or paralysis	_______
10. Pain and/or swelling in joints	_______
11.Abdominal pain	_______
12. Constipation	_______
13. Diarrhea	_______
14. Bloating, belching or intestinal gas	_______
15.Troublesome vaginal burning, itching or discharge	_______
16. Prostatitis	_______
17. Impotence	_______
18. Loss of sexual desire or feeling	_______
19. Endometriosis or infertility	_______
20. Cramps and/or other menstrual irregularities	_______
21. Premenstrual tension	_______
22. Attacks of anxiety or crying	_______
23. Cold hands or feet and/or chilliness	_______
24.Shaking or irritable when hungry	_______
Total Score, Section B	_______

Section C: Other Symptoms*

For each symptom that is present, enter the appropriate number in the Point Score column:

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 severe and/or persistent, score 9 points.Total the score for this section and record it in the box at the end of this section.
Point score

1. Drowsiness	_______
2. Irritability or jitteryness	_______
3. Incoordination	_______
4. Inability to concentrate	_______
5. Frequent mood swings	_______
6. Headaches	_______
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. Recurrent infections or fluid in ears	_______
32.Ear pain or deafness	_______

*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.

Total Score, Section C _______

Total Score, Section B _______

Total Score, Section A _______

Grand Total Score
(add totals from Sections A, B and 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 questionnaire apply exclusively to women, while only 2 apply exclusively to men.

Yeast-connected health problems are almost certainly present in women with scores over 180, and in men with scores over 140.

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 health problems