Avoteinu: Avraham, Yitzhak, v'Yaakov, v'Imoteinu: Sarah, Rivka, Rachel v'Leah, Hu yivarekh virapei et haholeh/haholah _____ ben/bat ______
HaKadosh Barukh Hu yimalei rahamim alav/aleha, l'hahalimo/l'hahlimah, u-l'rap'oto/u-l'rap'otah, l'hahaziko/l'hazikah, u-l'hay-oto/u-l'hay-otah.
V'yishlah lo/lah bim-hera r'fuah shlemah, r'fu-at hanefesh u-r'fu-at hagoof,
b'tokh sh'ar holei Yisrael v’holei yoshvei tevel,
hashta ba'agalah u-vizman kariv,
An English Translation
May the One who blessed our ancestors -- Patriarchs Abraham, Isaac, and Jacob, Matriarchs Sarah, Rebecca, Rachel, and Leah bless and heal the one who is ill: __________ son/daughter of _________.
May the Holy Blessed One overflow with compassion upon him/her, to restore him/her, to heal him/her, to strengthen him/her, to enliven him/her.
The One will send him/her, speedily, a complete healing --
healing of the soul and healing of the body along with all the ill,
among the people of Israel and all humankind, soon, speedily, without delay, and let us all say: Amen!