O Christ Jesus, I am sinful dust and ashes,

but Thou callest to Thee all who labour and are burdened,

that Thou mayest refresh them.

Art not Thou my refuge?

To whom else shall I go?

Thou hast the words of eternal life,

Thou alone canst comfort me in every trouble.

Lord, I am weak and sick,

but Thou art my salvation.

Those who are well need not a physician,

but those who are sick.

Therefore I come to Thee,

my physician and my refuge,

hoping that this Communion may be to me

the increase of Faith, Hope, and Charity;

a firm defence against the snares of my enemies;

a help to the removal of the fault and defect of

(Mention your faults here...),

and to the bringing forth of works well pleasing unto Thee,

especially...,

and a pledge of future glory.

This is the hope and desire which I cherish in my heart,

for Thou art compassionate and of tender mercy,

and in all Thy promises most faithful.

Amen.