Question Sheets  
 
Candida Short Questionnaire

















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Candida Long Questionnaire

Candida Short Questionnaire

Blood Sugar Questionnaire

Syndrome X Questionnaire

  Enter a number (from 0 - 5) after each of the following symptoms related to Candida. Zero (0) would represent "not present"; 5 would represent very severe expression of the symptom.
What is your gender? 
Male
Female
0 1 2 3 4 5
Vaginal discharge
Frequent urination
Bladder infections
Sensitivity to smoke, perfume, insecticides, dry cleaning fumes, chemical fumes
All symptoms increase in dampness or on muggy days
Athlete's foot, ringworm, "jock itch"
Do you crave sugar?
Do you crave bread?
Do you crave wine or beer?
Do you crave peanuts?
Do you crave oranges?
Do you crave grapes or raisins?
Fatigue or lethargy
Feeling "drained"
Feeling "spacey" or "unreal"
Depression
Numbness
Abdominal pain
Constipation
Diarrhea
Bloating
Low sex drive
Cramps and/or menstrual irregularities
Spots in front of eyes
Irritability
Inability to concentrate
Mood swings
Headaches
Dizziness/loss of balance
Itching
Rashes
Heartburn
Indigestion
Belching and/or passing gas
Burning anus
Bad breath
Nasal congestion
Burning or tearing of eyes




Total Score on Short Questionnaire: 
(Treatment is recommended if females score
above 20 or males are above 15)

Please refer to the Candida Diet for a recommended program.