Candida Symptom Assessment Questionnaire

The new WholeApproach® diet recommendations are customized by you to address your individual needs. Everyone starts their program at different levels of wellness and as they move along their healing journey, they improve at different rates. It only makes sense to follow a program that is as unique as you are.

This new diet protocol utilizes a weekly questionnaire upon which to base your ongoing diet recommendations and transitions. Rather than insisting that you stay on the strictest of candida diets for the entire recovery period, the new guide will help you to decide when you are well enough to experiment with the reintroduction of a less stringent diet.

This questionnaire will help you maintain objectivity about your progress while enhancing your self-awareness. Using the Questionnaire as a way of measuring your progress helps to determine when to reintroduce restricted foods and eventually, when to transition to a healthy maintenance regimen.

Download printable WholeApproach® Symptom Assessment Questionnaire


Instructions

Score each symptom between 0-10 depending on the severity and the degree to which it applies to you; with 10 indicating the most severe of symptoms and zero indicating that the symptom does not apply to you.

This questionnaire is designed to be completed once a week; on the same day, at the same time of day. Record your scores in your HealthMinder Health Journal or calendar.

Symptoms 0 1 2 3 4 5 6 7 8 9 10
Aching Muscles
Alcohol Cravings
Anxiety
Bread/Starch Cravings
Bronchitis/Cough
Chest Pain or tightness
Constipation
Co-ordination Problems
Depression, Lethargy
Disorientation/Confusion
Dizziness
Ear Infections - frequent
Emotionally over-sensitive
Erectile Difficulties
Eye tearing or burning
Forgetfulness
Foul smelling body odor
Foul smelling breath
Frequent colds and flues
Frequent bladder or prostate infections
Headaches
Heartburn
Hives
Hunger causes shakes or irritability (low blood sugar)
Indecision
Infertility or Endometriosis
Intestinal Discomfort/pain
Intolerant to mold
Irritability/Jumpiness
Itching in Rectum
Itchy Ears/Nose
Joint Pain
Loose Stools
Menstrual Irregularities
Mucus in stools
Multiple Food Intolerances
Nasal or Sinus congestion
Numb/Tingling or Burning Sensations
Oral Thrush
Panic Attacks
Perfume/Chemical Sensitivity
Poor Balance
Poor Concentration
Post nasal drip
Pre-Menstrual Stress
Prostatitis
Psoriasis/ Eczema/Skin Rash
Radical Mood Shifts
Reactions to yeast
Reduced Libido
Sleep Disturbances
Sore Throat (chronic)
Spacey Feeling
Spots in Front of Eyes
Sugar Cravings
Tearfulness
Tire Easily/ Chronic Fatigue
Tobacco Smoke Intolerance
Tongue has white coating
Vaginal Yeast Infections
Weak Digestion/Bloating/Gas
Weakness/ Trembling
More than one pregnancy or use of birth control pills for more than six months?YesNo
Antibiotics for longer than three weeks or more than four short treatments over a two year period in last ten years?YesNo
Use of Steroid, Immunosuppressant or Anti-Viral Drugs for a total of 4 weeks or more in the last five years?YesNo