O Mary, Immaculate Conception, perfect in all virtues, the One who overcomes temptation and sin, I entrust to you the well-being, salvation and purification of the soul of... (Name of the person). Deign to heal that soul of all its wounds, of all traces of sin and especially of what induces it to sin, so that through a true contrition, purpose of amendment and a good confession (name of the person) can obtain the grace of God, in the name of the Father, and of the Son, and of the Holy Ghost. Amen. (Make the sign of the Cross and give thanks to Our Lady).
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