In English:
He Who blessed our forefathers Abraham, Issac, and Jacob, Moses, Aaron, David, and Solomon – may He bless and heal the sick persons: – insert patient’s Hebrew Name, son/daughter of patient’s mother’s Hebrew name – on behalf of the whole congregation’s prayer for them. In reward for this, may The Holy One, blessed is He, be filled with compassion for them to heal them, to strengthen them, and to revive them. And may He send them speedily a complete recovery from heaven, for all limbs and blood vessels, among the sick people of Israel, a recovery of the spirit, and a recovery of the body, swiftly and soon. And you shall say Amen.
In Hebrew: