(If the prayer is for a woman, use the feminine pronoun where necessary.)

O Mary, Queen of the Angels and of men, 
behold me an unworthy servant and listen to my prayer
in behalf of (Name) who remains separated from the Church
established by thy Divine Son.

My Mother, dispensatrix of grace, strip from (Name)
the bands of prejudice and ignorance that hold him captive,
and let the true light of Faith enlighten his mind and quicken his will.

Gently draw him my Mother, into the fold of Christ, 
that his salvations may be better secured and that the
Kingdom of God upon earth may grow stronger over
the infernal enemy.

Amen