"In the Sutra it says, 'This good excellent medicine now I leave here. You should take and swallow it. Do not worry that you will not be cured.' It also says, 'This Sutra then is the Excellent medicine for the sick people of Jambudvipa. If there shall be sick people who are able to hear this Sutra, the sickness shall at once dissipate and they shall not die before they grow old.' In the Sublime Writings of Nichiren Shonin it says, 'Though one were to point at the earth and miss, though there were those who snare the empty sky, though the tide were not to come in, though the sun were to rise from the west, it cannot be that the prayers of the Practitioner of the Hokekyo ever fail."
____________________, aged _____ years, repents of all the beginningless Blasphemy against the Dharma, evil karma, and words and deeds contrary to the Mind of the Lord Buddha. We respectfully pray that his (her) sins and hindrances be dissipated and extinguished and his (her) illness be rapidly cured and that you may protect his (her) bodily health.
Namu Myoho renge kyo