DYSBIOSIS QUESTIONNAIRE

YES NO

1. Have you ever taken antibiotics for a month or more? ☐ ☐

2. Have you taken a broad-spectrum antibiotic three or more times per year? ☐ ☐

3. Have you taken at least one round of broad-spectrum antibiotics annually for two years? ☐ ☐

4. Have you ever felt brain fog after eating bread or pasta? ☐ ☐

5. Have you ever had oral thrush? ☐ ☐

6. Have you ever had yeast vaginitis? ☐ ☐

7. Have you taken prednisone or cortisone for more than two weeks? ☐ ☐

8. Have you taken birth control pills for more than two years? ☐ ☐

9. Have you ever had fungal skin problems (athlete's foot, ringworm, or nail fungus)? ☐ ☐

10. Do you crave sugar? ☐ ☐

11. Do you crave bread or pasta? ☐ ☐

12. Do you crave alcohol or cheese? ☐ ☐

13. Are you intolerant to perfumes, fragrances, or chemical odors? ☐ ☐

14. Do you have regular bouts of bloating and gas? ☐ ☐

15. Do you have vaginal itching or discharge? ☐ ☐

16. Do you have regular abdominal pain, constipation, or diarrhea? ☐ ☐

17. Do you have food sensitivities or intolerances? ☐ ☐

18. Do you have rectal itching? ☐ ☐

19. Do your bloating and gas symptoms get worse when you eat aged cheese, drink alcohol, or drink soy sauce? ☐ ☐

20. Have you ever taken chemotherapy drugs for cancer? ☐ ☐

Points for each “yes” answer:

Questions 1–2: 10 points each Subtotal_________

Questions 3–8: 5 points each Subtotal_________

Questions 9–20: 2 points each Subtotal_________

Total_________

Precision nutrition