Yeast Questionnaire Calculator

Yeast Questionnaire Calculator

Gender Selection

Gender:

Section A: History

1. Have you ever taken tetracyclines or other antibiotics for acne for 1 month (or longer)? Yes (25 points)

2. Have you taken other “broad spectrum” antibiotics for 2 months or longer, or shorter courses 4+ times in a year? Yes (20 points)

3. Have you been bothered by persistent prostatitis, vaginitis, or other reproductive organ problems? Yes (25 points)

4. Have you been pregnant…(Male Ignore this Question)

2 or more times? (5 points)

1 time? (3 points)

5. Have you taken birth control pills…(Male Ignore this Question)

For more than 2 years? (15 points)

For more than 6 years? (8 points)

6. Have you taken Prednisone, Decadron, or other cortisone-type drugs…

For more than 2 weeks? (15 points)

For 2 weeks or less? (6 points)

7. Does exposure to perfumes, insecticides, etc., provoke…

Moderate to severe symptoms? (20 points)

Mild symptoms? (5 points)

8. Are your symptoms worse on damp, muggy days or in moldy places? Yes (20 points)

9. Have you had athlete’s foot, ringworm, “jock itch,” or other chronic skin/nail infections?

Severe or persistent? (20 points)

Mild to moderate? (10 points)

10. Do you crave sugar? Yes (10 points)

11. Do you crave breads? Yes (10 points)

12. Do you crave alcoholic beverages? Yes (10 points)

13. Does tobacco smoke really bother you? Yes (10 points)

Section B: Major Symptoms

For each symptom, select the severity:

1. Fatigue or lethargy

2. Feeling of being “drained”

3. Poor memory

4. Feeling “spacey” or “unreal”

5. Depression

6. Inability to make decisions

7. Numbness, burning, or tingling

8. Muscle aches or weakness

9. Pain and/or swelling in joints

10. Abdominal pain

11. Constipation

12. Diarrhea

13. Bloating, belching, or intestinal gas

14. Troublesome vaginal burning, itching, or discharge

15. Persistent vaginal burning or itching

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

Section C: Other Symptoms

For each symptom, select the severity:

1. Drowsiness

2. Irritability or jitteriness

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. Numbness, tingling

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. Bad breath

20. Nasal congestion or postnasal 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. Urgency or urinary frequency

28. Burning upon 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

Results

Total Score, Section A:

Total Score, Section B:

Total Score, Section C:

Grand Total Score:

Interpretation:

Questionnaire source: ©Copyright by William G. Crook, MD, Author of Yeast Connection.