sophcalh on "Contact form only working on homepage?"

My site is http://personalhealthmd.com/. If you scroll down, you see a globe with the words "International Patient Portal." When you click it, a contact-form like box pops up prompting for a password. I believe code for this is inside the fourth column footer Widget, and the code is as follows:

<div class="fouth-img"><a href="#ct-frm" class="fancybox"><img src="http://personalhealthmd.com/wp-content/uploads/2013/04/globe_2013-04-29.png"></a></div>

<div class="cntct-frm" id="ct-frm" position="bottom">
<div class="cntct-frm-inner">
<h4> International Patient Portal</h4>
[raw]
[contact-form subject="Subject Line to Email Here" to="abroderick@personalhealthmd.com"]

[contact-field label="Personal Health MD assigned password" type="text" /]
[contact-field type="hidden"/]
[/contact-form][/raw]
<br class="clear">
</div></div>

It works on the homepage, but on every other page, clicking on the globe will not open anything. What can I do to make it function on every page?

Thanks a lot.