The research on the perception of health risks from heat wave and coping behaviors among mountain residents is very limited. Adopting a multi-stage sampling method, this study received completed questionnaires from 1 008 local residents from five counties in Wuling mountain area in 2017. the structural equation model was used to explore the factors influencing residents' perception and coping behavior. Results showed that the participants had the strong perception of the health risk of heat wave climate, but they had a weak awareness of risk prevention and lack of professional health knowledge. 66.4% of the participants felt that the weather was getting warmer in recent years, and 71.8% of the participants believed that the heat wave would pose a threat to health, and 60.6% of them had undergone physical discomfort during heat wave. There were 92% of the participants responding to the heat waves, 67.5% would seek help when threatened by health risks of heat wave. However, only 12% had the information or knowledge to stay healthy during the heat wave, and only 23.8% of them would prepare before the heat wave . It is concluded that employment status, gender and disease status were factors that made influences on mountain residents' perception and adaptation to heat wave climate. Finally, for the sake of reducing the impact of extreme high temperature events on the health of mountain residents, it is proposed to hold health education and promotion activities, establish extreme weather warning system, strengthen public health facilities, and roll out plans and strategies to respond contingencies.