Have you at any time in your life taken other broad spectrum antibiotics (respiratory, urinary, or other infections (for 2 months or longer or in shorter courses 4 or more times in one year)? *

Yes

Have you taken broad spectrum antibiotic drug, even a single course? *

Yes

Have you at anytime in your life been bothered by persistent prostatitis, vaginitis, vaginitis, or other problems affecting your reproductive organs? *

Yes

Have you been pregnant? *

Once

More than once

Have you taken birth control? For 6 months - 2 Years *

Yes

Have you taken birth control? For more than 2 years? *

Yes

Have you taken prednisone, decadron, or other cortisone type drugs? (2 weeks or less) *

Yes

Have you taken prednisone, decadron, or other cortisone type drugs? (more than 2 weeks) *

Yes

Does exposure to perfumes, insecticides, fabric shop odors and other chemical smells provoke symptoms? (Moderate to severe symptoms) *

Mild

Moderate/ severe

Are your symptoms worse on damp, muggy days or in Moldy places? *

Yes

Have you had athlete's foot, ringworm, "jock itch," or other chronic fungus infections of the skin or nails? *

Mild/ Moderate

Severe/ Persistent

Do you crave sugar? *

Yes

Do you crave breads? *

Yes

Do you crave alcoholic beverages? *

Yes

Does tobacco smoke really bother you? *

Yes

Total score

Candida Questionnaire (1)

Click Submit to finish.

This questionnaire has been adapted from The Institute of Functional Medicine. Modifications were made to suit specific needs.

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