Classified as self and non-self-referrals, the ideal situation is that patients begin from lower levels of healthcare to higher levels. This improves the utilization of the primary care units, reduces unnecessary congestion of higher levels and makes for efficient healthcare delivery in general. This study aimed to assess the prevalence and predictors of self-referral among patients accessing healthcare in a tertiary hospital in Calabar, Nigeria. Ethical approval and informed consent were obtained. The study adopted quantitative data collection methods. This facility-based, cross-sectional study was carried out among 400 patients aged 18 years and above accessing care in the General Outpatient Clinic of the University of Calabar Teaching Hospital, Calabar in Cross River State. Overall, 191(47.8%) were males while 209(52.3%) were females. The mean age of study participants was 40.5±13.4 years, the most common age group was 31 to 40 years (28.2%). Prevalence of self-referral was 68.3%. Factors significantly associated with self-referral practices were sex (p<0.001), age group (p<0.001), marital status (p<0.001) and occupation (p=0.006). At multivariate regression analysis, females compared with males (OR: 5.299; 95% CI: 3.271 to 8.587), as well as those who were presently unmarried compared with those presently married (OR: 1.920; 95% CI: 1.052 to 3.505) were significantly more likely to practice self-referral. Self-referral practice is common and sex and marital status were identified as predictors. This is more so with unmarried females. Interventions to promote utilization and referral by healthcare providers through the prescribed channel is strongly recommended. Keywords: Self- referral, Prevalence, Predictors, Healthcare, tertiary, Practice.