Medical History Check List:

*Repeated antibiotics during childhood:_____

*Acne during teen years:_____

*Recurrent urinary infections:_____

*Frequent Vaginitis:_____

*Jock itch:_____

*Sexual dysfunction:_____

*Fatigue, headache, depression:_____

*Visits to many different physicians:_____

*Digestive symptoms:_____

*Crave sweets:_____

*Feel sick all over:_____

Section A: History

1. Have you taken tetracyclines or other antibiotics for acne for 1 month (or longer)? 35 points

2. Have you at any time in your life taken broad-spectrum antibiotics or other antibacterial medications for respiratory, urinary or other infections for two months or longer, or in shorter courses four or more times in one year? 35 points

3. Have you taken a broad-spectrum antibiotic drug-even in a single dose? 6 points

4. Have you at any time in your life, been bothered by persistent prostatitis, vaginitis, or other problems affecting your reproductive organs? 25 points

5. Are you bothered by memory or concentration problems-do you sometimes feel spaced out? 20 points

6. Do you feel "sick all over" yet, in spite of

visits to many different physicians, the causes have no been found? 20 points

7. Have you been pregnant...2 or more times? 5 points

one time? 3 points

8. Have you taken birth control pills...

for more than two years? 15 points

for six months to two years? 8 points

9. Have you taken steroids orally, by injection or inhalation...

for more than two weeks? 15 points

for two weeks or less? 6 points

10. Does exposure to perfumes, insecticides, and other chemicals provoke...

moderate to severe symptoms? 20 points

mild symptoms? 5 points

11. Does tobacco smoke really bother you? 10 points

12. Are your symptoms worse on damp, muggy days, or in moldy places? 20 points

13. Have you had athlete's foot, ring worm, jock itch, or other chronic fungal infections of the skin or nails? Have such infections been...

severe or persistent? 20 points

mild to moderate? 10 points

14. Do you crave sugar? 10 points

Total Score, Section A ______

Section B: Major Symptoms

Does Not Apply=0 points

Mild Or Occasional=3 points

Moderate Or Frequent=6 points

Severe Or Disabling=9 points

 1. Fatigue or lethargy_____

2. Feeling of being drained_____

3. Depression or manic depression_____

4. Numbness, burning or tingling_____

5. Headache_____

6. Muscle aches_____

7. Muscle weakness or paralysis_____

8. Pain and/or swelling in joints_____

9. Abdominal pain_____

10.Constipation and/or diarrhea_____

11. Bloating, belching or intestinal gas_____

12. troublesome vaginal burning, itching or discharge_____

13. Prostatitis_____

14. Impotence_____

15. Loss of sexual desire or feeling_____

16. Endometriosis or infertility_____

17. Cramps and/or other menstrual irregularities_____

18. Premenstrual tension_____ 

19. Attacks of anxiety or crying_____

20. Cold hands or feet, low body temperature_____

21. Hypothyroidism_____

22. Shaking or irritable when hungry_____

23. Cystitis or interstitial cystitis (bladder inflammation)_____

Total Score, Section B _______

Section C, Other Symptoms

Does Not Apply=0 points

Mild Or Occasional=1 point

Moderate Or Frequent=2 points

Severe Or Disabling=3 points

1. Drowsiness, including inappropriate drowsiness_____

2. irritability_____

3. uncoordination_____

4. Frequent mood swings_____

5. Insomnia_____

6. Dizziness/loss of balance_____

7. Pressure above ears...feeling of head swelling_____

8. Sinus problems...tenderness of cheekbones or forehead_____

9. Tendency to bruise easily_____

10. Eczema, itching eyes_____

11. Psoriasis_____

12. Chronic hives (urticaria)_____

13. Indigestion or heartburn_____

14. Sensitivity to milk, wheat, corn or other common foods_____

15. Mucus in stools_____

16. Recta or erratic vision_____

17. Burning or tearing eyes_____

18. Recurrent infections or fluid in ears_____

19. Ear pain or deafness_____

Total Score, Section C _______

Total Score, Section A _______

Total Score, Section B _______

Total Score, Section C _______

Grand Total Score _______

*If score is MORE THAN 180 in women and MORE THAN 140 in men, systemic yeast is almost certainly present

*If score is MORE THAN 120 in women and MORE THAN 90 in men, systemic yeast is probably present.

* If score is MORE THAN 60 in women and MORE THAN 40 in men, systemic yeast is possibly present.

*With scores LESS THAN 60 in women and LESS THAN 40 in men, systemic yeast is less likely to cause health problems.

The products listed here are used in the treatment of Systemic Yeast Infection or Candidiasis (Candida Albicans). We recommend that you consult with Dr. Castaneda, Dr. Wright or another health care practitioner for the best treatment for your individual case.

Mycostat: Sustained release anti-candida formula.

Olive Leaf Extract: Anti-fungal, anti-viral. This product is a naturopathic prescription product and used for difficult cases.

Grapefruit Seed Extract: Take this product for 4 weeks as directed on label. Very powerful!

Prodophilus: Naturopathic grade of Lactobacillus and Bifidobacterium.

SuperII: You must keep the bowels clean, that is where yeast overgrowth starts.

Stevia Extract: You must eliminate sugar from the diet. Sugar feeds yeast.