Boron doped diamond (BDD), given the robustness of the material, is becoming an electrode of choice for applications which require long-term electrochemical monitoring of analytes in aqueous environments. However, despite the extensive work in this area, there are no studies which directly assess the biofilm formation (biofouling) capabilities of the material, which is an essential consideration because biofouling often causes deterioration in the sensor performance. Pseudomonas aeruginosa is one of the most prevalent bacterial pathogens linked to water-related diseases, with a strong capacity for forming biofilms on surfaces that are exposed to aquatic environments. In this study, we comparatively evaluate the biofouling capabilities of oxygen-terminated (O-)BDD against materials commonly employed as either the packaging or sensing element in water quality sensors, with an aim to identify factors which control biofilm formation on BDD. We assess the monospecies biofilm formation of P. aeruginosa in two different growth media, Luria-Bertani, a high nutrient source and drinking water, a low nutrient source, at two different temperatures (20 and 37 °C). Multispecies biofilm formation is also investigated. The performance of O-BDD, when tested against all other materials, promotes the lowest extent of P. aeruginosa monospecies biofilm formation, even with corrections made for total surface area (roughness). Importantly, O-BDD shows the lowest water contact angle of all materials tested, that is, greatest hydrophilicity, strongly suggesting that for these bacterial species, the factors controlling the hydrophilicity of the surface are important in reducing bacterial adhesion. This was further proven by keeping the surface topography fixed and changing surface termination to hydrogen (H-), to produce a strongly hydrophobic surface. A noticeable increase in biofilm formation was found. Doping with boron also results in changes in hydrophobicity/hydrophilicity compared to the undoped counterpart, which in turn affects the bacterial growth. For practical electrochemical sensing applications in aquatic environments, this study highlights the extremely beneficial effects of employing smooth, O-terminated (hydrophilic) BDD electrodes.