Although preconception care is a key element of motherhood health care services, the package is ignored in developing countries including Ethiopia and has not been generally adopted and applied since its aim and purposes are not broadly unstated and incorporated. Therefore, the objective of the current study was to determine the level of preconception care use and its determinants among women in Debre Tabor Town Northwest Ethiopia. From November 1 to 30, 2020, a Community-based cross-sectional study was undertaken in Debre Tabor Town. Overall, 79 (15.8%) with 95% CI [12.6, 19] of women had a good level of practice on preconception care utilization. Age (35–49; AOR = 5.12, 95% CI [2.14, 9.98]), ante natal care (AOR = 8.78, 95% CI [2.66, 28.97]), history of adverse birth outcome (AOR = 4.89, 95% CI [3.09, 17.00]), presence of chronic disease (AOR = 7.51, 95% CI [2.33, 12.13]), and knowledge on preconception care (AOR = 3.55, 95% CI [1.57, 8.02]) were significantly associated with utilization of preconception care. Hence, the government and respective stakeholders must give establish on preconception care strategies and plan that covers all aspects of preconception care. Incorporation of the service with other maternal and child health service will be crucial when developing actual employment policies to scale up acceptance of preconception care.