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Here is a great way to assess your health needs. We provide health questionnaires to help you identify problem areas within your health.

Health Questionnaires

Candida | Gluten Sensitivity | Food Allergies | Hypoglycemia

(All information is held in strict confidentiality and will not be shared or sold)

CANDIDA QUESTIONAIRE: Section A

Full Name:
Email Address:
Confirm Email Address:
Phone:

Age:

Sex:

Weight:

Height:

( Inches )

This questionnaire is designed for adults, and the scoring system is not 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). Filling out and and scoring this questionnaire should help you and your physician evaluate the role of candida in contributing to your health problem, yet it will not provide and automatic "Yes" or "No" answer.

Check all that apply:

SECTION A: HISTORY	Yes
1. Have you ever taken a broad spectrum antibiotic drug, even a single course?
2. Have you taken tetracyclines (or other antibiotics for acne) for 1 month (or longer)?
3. 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 shorter courses for 4 or more times in a 1-year period)?
4. Have you at any time in your life been troubled by persistant prostatitis, vaginal problems, or had 3 or more episodes of vaginitis in a year?
5. Have you taken prednisone, Decadron, or other cortisone-type drugs For more than 2 weeks?
For less than 2 weeks?
6. Have you been pregnant 2 or more times?
1 Time
7. Have you taken birth control pills For more than 2 years?
For 6 months to 2 years?
8. Does exposure to perfumes, insecticides, fabric shop odors, and other chemicals provoke Moderate to Severe symptoms?
Mild syptoms?
9. Are your symptoms worse on damp, muggy days or in moldy places?
10. Have you had athletes foot, ring worm, "jock itch" or other chronic fungus infections of the skin or nails ? Have such infections been Severe or persistent?
Mild to moderate?
11. Do you crave alcoholic beverages?
12. Do you crave Sugar?
13. Do you crave breads?
14. Does tobacco smoke REALLY bother you?

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