BODY BY DESIGN • AN LFH INTERACTIVE WORKBOOK CANDIDA HISTORY & CHECKLIST FORMS Candida Self Analysis The following History and Major Symptom Checklist has been prepared by Lindsey Duncan, CN. and CEO of Nature’s Secret. These support materials are provided based on his permission. History – Section 1 This section involves an understanding of your medical history and how it may have promoted Candida growth. Circle those comment to which you can answer yes. Record your total at the end of the section.
Throughout your lifetime, have you taken any antibiotics or tetracyclines (Symycin™, Panmycin™, Bivramycin™, Monicin™ etc.) for acne or other conditions, for more than one month?
Have you ever taken a “broad spectrum” antibiotic for more than two months or four or more times in a one-year period? These could include any antibiotics taken for respiratory, urinary or other infections.
Have you taken a “broad spectrum” antibiotic — even for a single course? These antibiotics include ampicillin™, amoxicillin™, Keflex™, etc.
Have you ever had problems with persistent prostatitis, vaginitis or other problems with your reproductive organs?
Women — Have you taken birth control pills:
If you were not breast-fed as an infant.
Have you taken any cortisone-type drugs (Prednisone™, Decadron™, etc.)?
9. Are you sensitive to and bothered by exposure to perfumes, insecticides
BODY BY DESIGN • AN LFH INTERACTIVE WORKBOOK
11. Are your symptoms worse on damp, muggy days or in moldy places?
12. If you have had chronic fungus infections of the skin or nails
(including athlete’s foot, ring worm, jock itch), have the infections been:
13. Do you crave sugar (chocolate, ice cream, candy, cookies, etc.)?
14. Do you crave carbohydrates (bread, bread and more bread)?
16. Have you drunk or do you drink chlorinated water (city or tap)?
Total Score Section 1 _ _ _ _ _ _ _ _ _ _ Major Symptoms – Section 2 For each of your symptoms, enter the appropriate figure in the point score column. BODY BY DESIGN • AN LFH INTERACTIVE WORKBOOK
18. Menstrual irregularities and/or severe cramps
21. Persistent vaginal burning or itching
BODY BY DESIGN • AN LFH INTERACTIVE WORKBOOK Total Score Section 2 _ _ _ _ _ _ _ _ _ _ Minor Symptoms – Section 3 For each of your symptoms, enter the appropriate figure in the point score column. BODY BY DESIGN • AN LFH INTERACTIVE WORKBOOK
15. Recurrent infections of fluid in the ears
19. Pressure above the ears (your head feels like it is swelling and tingling)
Total Score Section 3 _ _ _ _ _ _ _ _ _ _ BODY BY DESIGN • AN LFH INTERACTIVE WORKBOOK The Results Total Score _ _ _ _ _ _ _ _ _ _
If your score is 60+ (women) or 40+ (men), then you will pro b ably want to consider fo l l owing thes u ggestions found in this book.
As required by law, our office adheres to written policies and procedures to protect the privacy of information about you that we create, receive or maintain. Your answers are for our records only and will be kept confidential subject to applicable laws. Please note that you will be asked some questions about your responses to this questionnaire and there may be additional questions concerning y
BODY BY DESIGN • AN LFH INTERACTIVE WORKBOOK
BODY BY DESIGN • AN LFH INTERACTIVE WORKBOOK
BODY BY DESIGN • AN LFH INTERACTIVE WORKBOOK
BODY BY DESIGN • AN LFH INTERACTIVE WORKBOOK
BODY BY DESIGN • AN LFH INTERACTIVE WORKBOOK
BODY BY DESIGN • AN LFH INTERACTIVE WORKBOOK