Background Despite the fact that the disease has spread throughout the world, with millions infected and killed, global COVID-19 vaccine coverage remains low, particularly in developing countries including Ethiopia. Epidemiological data is insufficient to assess the amount of COVID-19 up take, willingness for vaccination, and associated factors. Objective This study aimed to assess COVID-19 up take, willingness for vaccination and associated factors among patients attending chronic follow up in the referral hospitals of Bahir Dar, Ethiopia, 2022 Method A hospital-based cross-sectional study was conducted among 400 patients attending chronic follow up in the referral hospitals of Bahir Dar from May 09 - June 09/2022. A systematic random sampling technique was used to select participants. Data was gathered using a pre-tested questionnaire, and checked for its consistency and accuracy. The data were entered to Epi data version 4.6 and analyzed using SPSS version 23. Descriptive analysis was performed to find the frequencies and percentages. Binary logistic regression analysis was done to assess the association between the dependent and independent variables. Variables having p-value < 0.25 in the bi-variable analysis were fitted into the multi-variable logistic regression. Finally, variables with p-value < 0.05 in the 95% confidence interval (CI) in the multi-variable binary logistic regression were considered as significant factors associated with the outcome variables. Results From a total of 423 participants, 400 (95% response rate) were included for analysis. The COVID-19 vaccine up take was less than 50% (46.8%), while the willingness for vaccination was 60.5%. About 56% and 68% of the respondents had good knowledge and favorable attitude respectively. Older people with age groups > 64 years were 2.7 times more likely to be vaccinated. Similarly, those people living in the urban area had 3.94 times increased COVID-19 vaccination. Furthermore, the probability of being vaccinated among respondents with good knowledge and favorable attitude were 70% and 79%, respectively. The willingness for vaccination was increased among those individuals with favorable attitude (AOR: 1.82). In contrast, urban people were less likely to be willing for COVID-19 vaccination (AOR: 0.46). The majority of the respondents (19.7% for vaccination to 35.7% for willingness for vaccination) misunderstood that the vaccine may aggravate their disease condition. Conclusion and recommendation The overall COVID-19 vaccine up take and willingness for vaccination was low compared to what was estimated by WHO. The majority of the respondents had good knowledge and favorable attitude. Age, residence, knowledge and attitude were factors associated with COVID-19 vaccine up take, while residence and attitude were associated with the willingness for vaccination. Increase accessibility of the vaccine, health education, strengthening vaccination campaign and community-based researches are recommended.