Objectives: Tobacco is an important risk factor for tuberculosis (TB) infection and TB disease. Identifying tobacco users and providing tobacco cessation services is expected to reduce the burden of TB. We assessed tobacco use among presumptive TB patients attending a tertiary hospital and their willingness to attend tobacco cessation services. Methods: A cross-sectional study was conducted among presumptive TB patients attending a designated microscopy center of a tertiary hospital in South India. All presumptive TB patients aged ≥ 18 years attending the designated microscopy center were interviewed using a semistructured interview schedule. Data on presumptive TB patient's age, sex, tobacco use and forms of tobacco, attempts to quit tobacco since 1 year, and willingness to attend a smoking cessation clinic in tertiary hospital were captured. History of use of tobacco in the past 1 month was considered as “tobacco use.”. Results: A total of 424 presumptive TB patients aged ≥ 18 years were interviewed. Tobacco use in the past 1 month was reported by 176 (41.5%, 95% confidence interval: 36.9–46.3%) presumptive TB patients. In total, 78 (18%) presumptive TB patients were eventually diagnosed with smear-positive pulmonary TB, of them 63 (80%) were tobacco users. Presumptive TB patients aged ≥ 30 years, male sex, and < 10 years of education were significantly associated with tobacco use. Of 176, a majority of 132 (75%) used some form of smoking. Of a total of 132 smokers, 70 (53%) were willing to avail of tobacco cessation services. Conclusion Tobacco use among presumptive TB patients was high. Considering the high willingness to quit among smokers, proven brief interventions to help quit smoking can be tried.