Heat waves threaten human health given the fast changing climatic scenarios in the recent past. Adaptation to heat waves would take place when people perceive their impacts based on their knowledge. The present study examines perception level and its determinants resulting in adaptation to heat waves in Pakistan. The study used cross-sectional data from urban and peri-urban respondents of Faisalabad District. The study employs a health belief model to assess risk perception among the respondents. Logistic model is used to determine factors affecting level of knowledge, perception and adaptation to heat waves. Around 30% of peri-urban respondents have a low level of knowledge about the fatal impacts of heat waves. Risk perception of heat waves is very low among urban (57%) and peri-urban (66%) respondents. Households' knowledge on heat waves is significantly related to age, gender, education, wealth and access to health services. Determinants of perception include knowledge of heat waves, age and joint effect of marital status and knowledge while income level, family size, urban/peri-urban background, perceived barriers, perceived benefits and cues to action significantly affect adaptation to heat waves. To reduce deadly health impacts, mass awareness campaigns are needed to build perception and improve adaptation to heat waves.