Background: Tuberculosis is a disease caused by an organism called Mycobacterium tuberculosis. Globally, 10.0 million people developed tuberculosis disease in 2017. Ethiopia is the third highest tuberculosis burden country in Africa. Health seeking behavior explains that people differ in their willingness to seek help from health care services. In Enebsie Sarmider Woreda, there were low tuberculosis detection rate (112/100,000) and low community tuberculosis suspects referral. Objective: Objective of this study is to assess health seeking behavior and associated factors among adult pulmonary tuberculosis suspects in Enebsie Sarmider Woreda, Amhara, Ethiopia, 2019. Methods: Community based cross-sectional study was conducted during March 27/ 2019 to April 27 / 2019 in Enebsie Sarmider Woreda. The study population were PTB suspects who were greater than or equals to 15 years old. Stratified multistage sampling technique was used. The sample size was 1710 individuals. Fourteen health extension workers and two health officers were recruited data collectors and supervisors respectively. The data were collected, coded, entered into EpiData versin3.1 and exported to Statistical Package for Social Science version 23 software for analysis. The descriptive data were presented by using table and graph. The significance of the study was presented by using odds ratio with 95%CIand p value less than 0.05. Results: The findings of study showed that 771(45.1%) pulmonary tuberculosis suspects with 95%CI 43-47% had health seeking behavior. Health seeking behavior was significantly associated with urban residence (AOR:3.54, 95%CI 2.08-6.02), educational status college and above (AOR:5.20,95%CI 2.61-10.34), secondary school (AOR:1.80, 95%CI 1.19-2.71), member of community based health insurance (AOR:4.06, 95%CI 3.22-5.11), hemoptysis (AOR: 1.99, 95%CI 1.49-2.65), duration of cough less than or equals to one month (AOR:2.25, 95%CI 1.74-2.92) and good knowledge (AOR:2.78, 95%CI 2.14-3.62). Conclusion and recommendation: The magnitude of health seeking behaviors among pulmonary tuberculosis suspects was 771(45.1%) with 95% confidence interval 43- 47%. Health seeking behavior among adult pulmonary tuberculosis suspects was significantly associated with educational level, knowledge, community based health insurance, hemoptysis, duration of cough and place of residence. Improving awareness for tuberculosis among rural community, membership of community health insurance, education, community awareness signs and symptoms of tuberculosis and availability rapid diagnostic tuberculosis test and slide transportation are required to improve health seeking behavior. Keyword: Ethiopia, cough, Health seeking behavior, Tuberculosis.