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In-depth Questionnaire

   

In-depth Questionnaire

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 disabling, score 9 points

Total the score for this section, and record it 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. Food, 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 _________________________________________________

Total Score, Section C _________________________________________________


Total Score, Section A ___________________________________________________

Total Score, Section B ___________________________________________________

Total Score, Section C ___________________________________________________

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.

This questionnaire is available in quantity from Professional Books, Inc., P.O.Box 3246, Jackson, TN 38302. Prices upon request. Copyright 1984. The Yeast Connection by William G. Crook, M.D. Reprinted with permission.

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