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Yeast Questionnaire
Fatigue or lethargy ______
Feeling of being drained _____
Depression or manic depression _____
Pain and/or swelling in joints _____
Abdominal pain _____
Constipation and/or diarrhea _____
Bloating, belching or intestinal gas_____
Indigestion or heartburn _____
Cramps and/or menstrual irregularities ______
Premenstrual tension (PMS) ___
Sore throat _____
Recurrent infections or fluid in ears_____
Chronic hives ( urticaria ) _____
Cough or recurrent bronchitis _____
Nasal congestion or postnasal drip _____
Nasal itching _____
Laryngitis, loss of voice _____
Eczema, itching eyes _____
Sensitivity to milk, Wheat , Corn, or other common foods _____
Mucus in stools _____
Psoriasis ______
Cystitis or interstitial cystitis ________
In coordination ____
Pressure above ears/feeling of head swelling_____
Troublesome vaginal burning, itching or discharge _____
Rectal itching _____
Dry mouth or Throat _____
Mouth rashes, Including ¡§ white¡¨ tongue ____
Bad breath _____
Foot, hair or body odor not relieved by washing _____
Pain or tightness in chest _____
Wheezing or shortness of breath _____
Urinary frequency or urgency _____
Burning on urination _____
Ear pain or deafness ___
If check more than 5, please see chapter on Yeast Overgrowth. You may want to begin taking the Yeast Formula and probiotics.
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