The purpose of this case study was to examine signs as a means of communicating fish consumption advisory information to English- and Spanish-speaking anglers in North Carolina. This study involved a group of stakeholders, including representatives from local and state agencies, non-governmental organizations, and academia, as well as 38 anglers in focus group discussions to learn about their knowledge and beliefs in the context of fishing in polluted waterways, including what they knew about fish consumption advisories and their perceptions of prototype signs. Across groups, participants identified two confusing elements of signs: the allowable number of servings of fish under advisory and distinct consumption recommendations for different subgroups. They recommended streamlined messaging and the use of visuals, lay terms, and locally relevant languages as ways to improve prototype signs. Additionally, participants identified the state wildlife agency as a common source of information about fish safety, more so than signs. These results suggest opportunities for improved communication of advisories, especially to the most at-risk populations.