OBJECTIVES Little is known about HPV vaccine communication tools currently used by primary care providers of adolescents, or how such tools impact the quality of HPV vaccine recommendations, which some have defined as using a "presumptive" communication style, continuing to offer vaccines despite resistance, and strongly recommending vaccines at the appropriate ages. We surveyed primary care providers to assess their current use of HPV vaccine communication tools, and how these related to their HPV vaccine recommendation quality. STUDY DESIGN Cross sectional survey of 183 pediatrics and family medicine primary care providers in the Denver metro area. RESULTS Response rate was 82% (n=150). Most (59%) providers used a presumptive vaccine recommendation >75% of the time, and 76% reported continuing to offer the HPV vaccine even after parent refusal. However, less than two-thirds of providers "strongly" recommended the vaccine to 11-12year olds (60% for females, 55% for males, p=0.02). The HPV vaccine information sheet from the Centers from Disease Control and Prevention was the most frequently used communication tool during clinical visits (64% used at least 75% of the time) and directing parents to preferred websites was the most frequently used between-visit communication tool (21% used >50% of visits). Use of tools was not associated with any measure of HPV vaccine recommendation quality but was associated with longer HPV vaccine discussion times. CONCLUSIONS Providers use only limited types of adolescent HPV vaccine communication tools, and frequently do not use preferred vaccine communication strategies. Better engagement with existing HPV vaccine communication tools, and/or the creation of new tools may be needed to enhance providers' ability to provide high quality HPV vaccine recommendations.