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Candida Questionnaire and Score Sheet
The following questionnaire is provided by the gracious work and permission of Dr. William Crook. For information on contacting Dr. Crook's office, see below. 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 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 on the line 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 candida in contributing to your health problem. They it will not provide an automatic "Yes" or "No" answer. Section A: History
Question
1. Have you taken tetracycline's (or other antibiotics) for 2 months (or 2. Have you, at any time in your life, taken other "broad spectrum" antibiotics (Including Keflex®, ampicillin, amoxicillin, Ceclor®, Bactrim®, and Septra®*) for respiratory, urinary or other infections (for 2 months or longer, or in shorter courses 4 or more times in a 1-year period? 3. Have you, at any time in your life, been troubled by persistent vaginal problems or had 3 or more episodes of vaginitis in a year? 4a. Have you been pregnant 2 or more times? 5a. Have you taken birth control pills for more than 2 years? 6a. Have you taken prednisone, Decadron® or other cortisone-type drugs for 7a. Does exposure to perfumes, insecticides, fabric shop odors and other chemicals provoke. Moderate to severe symptoms? Radiance Health Center, www.radiancehealthcenter.com 8. Are your symptoms worse on damp, muggy days or in moldy places? 9a. Have you had persistent athlete's foot, "jock itch", or other chronic fungous infections of the skin or nails? Have such infections been . Severe 13. Does tobacco smoke really bother you? *Such antibiotics kill off "good germs" while they're killing off those which cause infection. Section B: History
For each symptom which is present, enter the appropriate figure in the Point Score column: If a symptom is mild: score 3 points.
If a symptom is moderate: score 6 points.
If a symptom is severe or disabling: score 9 points.
Add total score for this section and record it on the line at the end of this section. 4. Feeling "spacey " or "unreal" Radiance Health Center, www.radiancehealthcenter.com 15. Persistent vaginal burning or itching Section C: Other Symptoms
For each symptom which is present, enter the appropriate figure in the Point Score column: If a symptom is mild: score 1 points.
If a symptom is moderate: score 2 points.
If a symptom is severe or disabling: score 3 points.
Radiance Health Center, www.radiancehealthcenter.com Add total score for this section and record it on the line at the end of this section. *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. 8. Pressure above ears.feeling of head swelling and tingling Radiance Health Center, www.radiancehealthcenter.com GRAND TOTAL SCORE (Add up Total Score for Sections A, B, and C) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Radiance Health Center, www.radiancehealthcenter.com Evaluation:
(Note that the scoring will be different for females and males since seven questions apply
exclusively to women, while only two apply exclusively to men.)
If your point score is over 180 in women (and 140 in men), candida almost certainly plays a
role in causing your health problems.
If your point score is over 120 in women (and 90 in men), candida probably plays a role in
causing your health problems.
If your point score is 60 to 120 for women (and 40 to 90 in men), candida possibly plays a role
in causing your health problems.
If your point score is less than 60 for women (and 40 for men), candida is less apt to be playing
a significant role in causing your health problems.
Radiance Health Center, www.radiancehealthcenter.com

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