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Candida Questionnaire and Score Sheet
This questionnaire lists factors in your medical history that 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 children, there is a different questionnaire. (For instance, a child does not have to have taken any antibiotics to have yeast problems.) Important Information: Please read before taking Candida Questionnaire.
Filling out and scoring this questionnaire should help you and your physician evaluate how
Candida albicans may be contributing to your health problems. However, it will not
provide an automatic yes or no answer. A comprehensive history and physical examination
are important. In addition, laboratory studies, x-rays, and other types of tests may also be
appropriate.
Section A: History Point Score
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.
Have you taken tetracyclines (Sumycin®, Panmycin®, Vibramycin®, Minocin®,etc.) or other antibiotics for acne for 1 month (or longer)? 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? Have you taken a broad spectrum antibiotic drug – even for one period? Have you, at any time in your life, been bothered by persistent Prostatitis, Vaginitis, or other problems affecting your reproductive organs? Have you taken birth control pills for more than 2 years? Taken birth control pills 6 months to 2 years? (I would add 30 Pts if around the time you started to take birth control pills, you had a general decline in your health.) Does exposure to perfumes, insecticides, fabric shop odors, or other chemicals provoke moderate to severe symptoms? Are your symptoms worse on damp, muggy days or in moldy places? 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? Total Score, Section A
Section B: Major Symptoms
**The use of nasal or bronchial sprays containing cortisone and/or other steroids promotes overgrowth in the respiratory tract.
If a symptom is occasional or mild, score 3 Pts.
If a symptom is frequent and/or moderately severe, score 6 Pts.
If a symptom is severe and/or disabling, score 9 Pts.
Feeling "spacey" or "unreal" Troublesome vaginal burning, itching or discharge Total Score, Section B
Section C: Other Symptoms*
*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.
If a symptom is occasional or mild, score 3 Pts.
If a symptom is frequent and/or moderately severe, score 6 Pts.
If a symptom is severe and/or disabling, score 9 Pts.
Pressure above ears, feeling of head swelling Foot, hair, or body odor not relieved by washing Urinary frequency, urgency or incontinence 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. Check your total score to the table below.
Point Score Table
Women
Men
Yeast-connected health problems are almost certainly present Yeast-connected health problems are probably present Yeast-connected health problems are possibly present Yeast are less apt to cause health problems Less than 60
Less than 40
From William G. Crook, M.D., “The Yeast Connection Handbook.” Professional Books. Jackson, TN 1997-2000. Reprinted with permission.

Source: http://www.enemabag.com/ohncurrent/documents/Candida-Questionnaire.pdf