River morphological quality assessment, derived from quantification of human pressures as well as river channel alteration, is a demand of the Water Framework Directive (WFD) in terms of integrating hydromorphological elements in defining ecological status. Our study's aim is to contribute to the hydromorphological evaluation by proposing indicators and separating classes, based on a revisited Morphological Quality Index (rMQI) protocol. The rMQI is based on 12 indicators of human pressures, 10 indicators of channel form adjustments, and 11 indicators of functionality. The rMQI scoring system allows for the quantification of changes when compared to reference conditions, be they undisturbed or nearly undisturbed by human interventions, with absent channel adjustments and a functioning natural river style. We used the lower, meandering sector of the Prahova River to demonstrate our assessment methodology. The Lower Prahova River suffers from a minor local intervention and a diminishing intensity of fluvial processes specific to a meandering style. Meanders geometry was affected by significant changes that included a decrease in the radius of curvature, width and width–to–mean–depth ratio. We concluded that the Lower Prahova River has a good morphological quality, which is rated as second class on a scale of five levels, from natural to severely modified. We recommend an improvement in the OPEN ACCESS Water 2015, 7 2972 hydromorphological evaluation protocol in Romania by additional indicators for morphological alterations specific to each channel pattern.