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=0.01). For professional development and education, 71 preferred a locally based workshop or seminar. Conclusions: The study highlights the need to consider closely the views of GPs when preparing rural communities for the possible health effects of climate change. Findings indicate concern for health service preparedness, particularly in smaller rural communities. Further development of disaster response planning and communication is needed.