So I did it.
With only a short myform_dialog (simple, without sections) with a new parameter for the image to display.
def myform_dialog(title='', fields=None,sections=None, done_button_title='Done',cover=None):
sections = [('', fields)]
c = dialogs._FormDialogController(title, sections, done_button_title=done_button_title)
y = 35
for s in c.cells:
for cell in s:
y = y + cell.height
if cover != None:
w = c.container_view.width
h = c.container_view.height - y
x = 0
cover_image = ui.ImageView(frame=(x,y,w,h))
cover_image.content_mode = ui.CONTENT_SCALE_ASPECT_FIT
cover_image.image = ui.Image.from_data(cover)
c.container_view.add_subview(cover_image)
c.container_view.present('sheet')
c.container_view.wait_modal()
# Get rid of the view to avoid a retain cycle:
c.container_view = None
if c.was_canceled:
return None
return c.values
