I understand now. We'll probably need Jon to help with this one. You might be able to put that form code into the subtitle field for the header. I'm not sure what character limit there is on that field.
I tested pasting the HTML for the form and Socrates accepted it. The only issue I saw is that Socrates headers are not as tall as the ones you are currently using and the form was a bit cramped. You would probably need to tweak the CSS for the headers and use taller ones.