Background: Family health history (FHH) is an underutilized tool in primary care to identify and risk-stratify individuals with increased cancer risk. Objective: Evaluate the influence of patient education on quantity and quality of FHH entered into a primary care-based software program, and impact on the program’s cancer risk management recommendations. Design: Two primary care practices within a larger type II hybrid implementation-effectiveness controlled clinical trial. Participants: English speaking non-adopted patients with a well visit appointment December 2012–March 2013. Interventions: One to two weeks prior to their well visit appointment, participants entered their FHH into the program. Participants were then provided educational materials describing key FHH components. They were instructed to use the interval to collect additional FHH information. Patients then returned for their scheduled appointment, and updated their FHH with any new information. Main Measures: Percentage per pedigree of relatives meeting individual quality criteria. Changes made after patient education and changes to recommendations for surveillance, chemoprevention or genetic counseling referral. Key Results: Post patient education, pedigrees exhibited a greater percentage (per pedigree) of: deceased relatives with age at death (84 vs. 81 % p = 0.02), deceased relatives with cause of death (91 vs. 87 % p = 0.02), relatives with a named health condition (45 vs. 42 % p = 0.002), and a greater percentage of relatives with high quality records (91 vs. 89 % p = 0.02). Of 43 participants with pedigree changes that could trigger changes in risk stratified prevention recommendations, 12 participants (28 %) received such changes. Conclusions: Patient education improves FHH collection and subsequent risk stratification utilized in providing actionable evidence-based care recommendations for cancer risk management.