From Rabbi Simon Glazer, Techinah: Prayers and Religious Duties for the Daughters of Israel (New York: The Star Hebrew Book Company, 1930), p. 70-72. Adapted by Hinda Tz. Eisen.
Merciful Father of all mankind, God of Abraham, Isaac, and Jacob! I come before You broken down in spirit and body, full of contrition and humility, to pray for the restoration of the health of [name of sick person]. Have compassion upon him/her; let no evil befall me by the misfortune of this dearly beloved member of my family.
You, O Lord, are mighty and righteous in judgment; who am I to advance my cause before Your Throne of Glory? But You, O Lord, know the needs of even Your smallest creature and provide sustenance for it. In Your hand are all living; our souls are Yours; so too our lives; our fate on this earth, and You alone have the right to judge us when our earthly cares no longer trouble our consciousness. In Your hand is the real cure of all sickness; You are the only source of all help and succor. But You did ordain in Your Torah, that when one is sick, medical aid must be given to relieve suffering, to effect a cure and to restore health and vigor.
May the doctor, under whose care the sick person now is, be Your true messenger of mercy and bring the proper remedy to this member of my family. […] May I be deserving to receive Your blessings for complete healing to this member of my family, speedily. Amen.