OBJECTIVE: To determine the knowledge and recommendations of rural general practitioners (GPs) in regard to climate change and the preparedness of rural health services for its health impacts. DESIGN: A quantitative descriptive survey distributed in paper-based or electronic form. SETTING: Rural Southwest of New South Wales. PARTICIPANTS: GPs and GP registrars working in Rural Remote Metropolitan Areas (RRMA) 3-7. MAIN OUTCOME MEASURES: Questionnaire responses analysed with descriptive statistics and inferential tests. RESULTS: While the majority of respondents agreed with statements supporting climate science and the impact of climate change on health, between 24% and 34% of respondents were unsure or did not agree. Furthermore, between 33% and 44% of GP respondents working in RRMA 5-7 were unsure or did not agree that their health service had the capacity to provide an initial response to an extreme weather event (P = 0.01). Strengthening health service acute disaster capacity response was a preferred adaptation strategy for improving health service preparedness of 61% of participants. A greater proportion of GPs were supportive of their role as advocates on general health issues (80%) compared with extreme weather events (60%) or climate change and health (63.5%) (P