No-reference video quality assessment (NR VQA) has recently seen promising progress with deep learning. However, video data is inherently large, and processing them with deep models incurs high computational cost. This challenge is particularly acute in VQA, where preserving original-resolution cues and dense temporal information is critical for accuracy. Existing efficiency-driven preprocessing strategies, such as fragmenting, reduce computation but alter the input data distribution, limiting effective reuse of pretrained video foundation models (ViFMs). To address these challenges, we propose \textbf{H}igh-\textbf{F}idelity \textbf{V}ideo \textbf{Q}uality \textbf{A}ssessment (\textbf{HFVQA}), a framework built on fixed-size spatio-temporal (ST) patches that is fully compatible with pretrained ViFMs. HFVQA samples ST patches across multiple scales, including the original resolution, with minimal temporal subsampling to preserve low-level quality cues and semantic context. To limit computation, HFVQA introduces a lightweight auxiliary network trained end-to-end with the ViFM encoder to learn \textit{VQA-specific saliency}. Distilled directly from quality supervision, this saliency captures task-specific importance patterns, reflecting that video quality perception is dominated by a small subset of spatio-temporal regions. By combining high-fidelity spatio-temporal cues with learned, task-specific saliency, HFVQA achieves SOTA performance on standard NR VQA benchmarks while processing as little as 12\% of candidate ST patches, making high-fidelity ViFM-based VQA computationally tractable.

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